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

List of authors.
  • Michael Fang, Ph.D.,
  • Dan Wang, M.S.,
  • Josef Coresh, M.D., Ph.D.,
  • and Elizabeth Selvin, Ph.D., M.P.H.

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每2010 period and the 2015每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每high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007每2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015每2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011每2014 to 2015每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每2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure每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. (Funded by the National Heart, Lung, and Blood Institute.)

Funding and Disclosures

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.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Coresh reports owning stock options in Healthy.io; and Dr. Selvin, receiving lecture fees from Novo Nordisk. No other potential conflict of interest relevant to this article was reported.

Author Affiliations

From the Welch Center for Prevention, Epidemiology, and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Address reprint requests to Dr. Selvin at the Welch Center for Prevention, Epidemiology, and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Baltimore, MD 21287, or at .

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