Diabetes treatment, control, and hospitalization among adults aged 18 to 44 in Minnesota, 2013-2015

Introduction Of more than 300,000 adult Minnesotans who have received a diagnosis of diabetes, 16% are younger than 45 years; however, state diabetes surveillance data primarily describe older adults. National reports suggest adults younger than 45 years are less likely than older adults with diabetes to meet blood glucose (hemoglobin A_1c [HbA_1c]) goals. For this study on age-specific differences, we examined Minnesota data sets to determine if younger adults (ie, aged 18-44 y) are less likely to meet HbA_1c goals and if hospitalization patterns differ from older adults (ie, aged 45-74 y) with diabetes. Methods We used Behavioral Risk Factor Surveillance System data to describe demographic characteristics and health behaviors of people with diabetes, clinical quality data to assess HbA_1c levels, and hospital discharge data to assess reasons for hospitalization. Results Compared with older adults with diabetes, adults aged 18 to 44 were more likely to use tobacco and to have had depression; these younger adults were less likely to report having HbA_1c levels checked in the last year. According to age-specific cutoffs, 40.5% of 18- to 44-year-olds met HbA_1c goals versus 74.7% of people aged 45 to 64 and 84.4% of people aged 65 to 74. Hospitalization rates for diabetes as a primary cause were highest among 18- to 44-year-olds at 47 per 1,000 adults with diabetes, much higher than older ages. Hospitalization rates for mental health problems were higher among younger adults. Conclusion Our analysis confirmed that 18- to 44-year-olds with diabetes have poorer HbA_1c control than older adults with diabetes. These results underscore the importance of age-based public health surveillance of diabetes. Age-stratified surveillance can inform efforts to monitor clinical care quality and to design clinical/public health interventions.