BACKGROUND AND PURPOSE:

• Fang et al. (NEJM, 2021) assessed national diabetes trends in the US including glycemic control, treatment and population subgroups most likely to have untreated risk factors

METHODS:

• Cross-sectional analysis of data
• Participants
  • US adults with diabetes participating in the National Health and Nutrition Examination Survey (NHANES)
• Study design
  • Glycemic control: Glycated hemoglobin level <7%
  • Lipid control: Non–high-density lipoprotein cholesterol level <130 mg per deciliter
  • Blood pressure control: <140/90 mm Hg
  • The authors analyzed data from 1999 through 2018

RESULTS:

Diabetes control improved from 1999 to the early 2010s, but later stalled and declined

• The number of adults who achieved glycemic control declined between the 2007-2010 period and the 2015-2018 period
  • 2007 to 2010: 57.4% (95% CI, 52.9 to 61.8)
  • 2015 to 2018: 50.5% (95% CI, 45.8 to 55.3)
• While there were major improvements in lipid control in the early 2000s, there was little improvement between 2007 to 2010 and 2015 to 2018
  • 2007 to 2010: 52.3% (95% CI, 49.2 to 55.3)
  • 2015 to 2018: 55.7% (95% CI, 50.8 to 60.5)
• The percentage of adults with good blood pressure control decreased between 2011 to 2014 and 2015 to 2018
  • 2011 to 2014: 74.2% (95% CI, 70.7 to 77.4)
  • 2015 to 2018: 70.4% (95% CI, 66.7 to 73.8)
• The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010
  • 2015 to 2018: 22.2% (95% CI, 17.9 to 27.3)
• Treatment trends
  • Use of glucose-lowering medication or any blood-pressure–lowering medication were unchanged after 2010
  • Use of statins plateaued after 2014
  • Use of combination therapy
    • Declined in those with uncontrolled blood pressure
    • Plateaued for those with poor glycemic control
• Population data
  • The following groups were less likely to receive treatment when targets were not achieved
    • Younger adults | Mexican Americans | Those without health insurance
  • Non-Hispanic Blacks compared to non-Hispanic Whites were
    • Less likely than to receive combination therapy when glycemic targets were not achieved
    • More likely to receive combination therapy when blood-pressure targets were not met

CONCLUSION:

• Despite a decade (1999 to 2010) of significant progress in controlling diabetes, adult NHANES participants have worse glycemic and blood-pressure control, and lipid control has leveled off
• The authors state

After steady declines from 1995 to 2010, rates of hyperglycemic emergencies and amputations of the feet or legs began increasing among U.S. adults with diabetes, while rates of end-stage renal disease, stroke, and acute myocardial infarction plateaued after 2010

These trends highlight the urgent need for interventions and strategies that safely resume progress in diabetes risk-factor control

Learn More – Primary Sources:

Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018

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ACC/AHA Blood Pressure Treatment Guideline: Lifestyle Modification and Drug Therapy

ACC/AHA Multisociety Guideline: Cholesterol Assessment and Primary ASCVD Prevention

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