TY - JOUR
T1 - Trends in diabetes treatment and control in U.S. adults, 1999–2018
AU - Fang, Michael
AU - Wang, Dan
AU - Coresh, Josef
AU - Selvin, Elizabeth
N1 - Funding Information:
Supported by grants (T32 HL007024, to Dr. Fang; and K24 HL152440, to Dr. Selvin) from the National Heart, Lung, and Blood Institute, National Institutes of Health.
Publisher Copyright:
Copyright © 2021 Massachusetts Medical Society.
PY - 2021/6/10
Y1 - 2021/6/10
N2 - BACKGROUND Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning. METHODS We conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018. RESULTS Diabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007–2010 period and the 2015–2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non–high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007–2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015–2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011–2014 to 2015–2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015–2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure–lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control. CONCLUSIONS After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off.
AB - BACKGROUND Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning. METHODS We conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018. RESULTS Diabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007–2010 period and the 2015–2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non–high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007–2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015–2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011–2014 to 2015–2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015–2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure–lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control. CONCLUSIONS After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off.
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U2 - 10.1056/NEJMsa2032271
DO - 10.1056/NEJMsa2032271
M3 - Article
C2 - 34107181
AN - SCOPUS:85107855163
VL - 384
SP - 2219
EP - 2228
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 23
ER -