Management of blood glucose, blood pressure, and lipids in patients with diabetes has improved markedly over the past decade, but achievement of goal levels is still suboptimal.
Only about half of patients achieved the American Diabetes Association (ADA) targets for each of these measures in the period from 2007 to 2010, and fewer than 1 in 5 achieved all 3 of the goals, according to data from the National Health and Nutrition Examination Surveys (NHANES).
“Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes- related morbidity and mortality,” write the authors of the study, which appears online in Diabetes Care (February 15, 2013).
The researchers assessed the proportion of diabetic patients achieving goals for hemoglobin (Hb) A1c, blood pressure, and low-density lipoprotein (LDL) cholesterol during the most recent NHANES (2007-2010) and previous NHANES (1988-1994, 1999-2002, and 2003-2006). The surveys included 4,926 adults at least 20 years old who reported a previous diagnosis of diabetes. Findings:
HbA1c goal < 7.0%
The overall prevalence of persons with diabetes achieving HbA1C <7.0% in 2007-2010 was 52.5%. More people 75 years and older met the HbA1C goal of <7.0% than those 20to 49 years old (P =0.022), and more non-Hispanic whites and non-Hispanic blacks met the goal than Mexican Americans. Over time, the prevalence of subjects with diabetes who achieved an A1C <7.0% significantly increased (1988–1994 and 1999–2002 vs. 2007–2010 (P <0.01 and P <0.05, respectively).
Blood pressure goal <130/80 mm Hg
In 2007–2010, the prevalence of individuals with diabetes having blood pressure <130/80 mm Hg was 51.1%. The prevalence of achieving blood pressure <130/80 mm Hg gradually decreased with increasing age (P <0.0001) and was greater for non-Hispanic whites than for non-Hispanic blacks (P =0.016).
The proportion of people who achieved BP <130/80 mm Hg significantly improved with each NHANES, with 33.2% in 1988–1994, 38.1% in 1999– 2002, 44.2% in 2003–2006, and 51.1% in 2007–2010 meeting this goal (P <0.05 for all estimates compared with 2007– 2010).
Between 1988–1994 and 2007– 2010, adults 50 years and older and all race/ethnic groups showed a significant improvement in the proportion meeting BP <130/80 mm Hg (all P <0.05); similar improvements were observed between 1999–2002 and 2007–2010.
LDL cholesterol goal <100 mg/dL
The overall prevalence of achieving LDL cholesterol <100 mg/dL in 2007-2010 was 56.2%. Older compared with younger individuals met the goal more often (P <.01); as did men compared with women (P =0.003); non-Hispanic whites compared with Mexican Americans, all Hispanics, or non-Hispanic blacks (all P <0.02); and high school graduates compared with those without a high school degree (P =0.045).
During 1988–2010, the prevalence of achieving LDL <100 mg/dL improved dramatically, from 9.9% in 1988–1994, 35.3% in 1999–2002, 48.0% in 2003–2006, to 56.2% in 2007–2010 (P <0.01 for all estimates compared with 2007–2010). This dramatic improvement over time was found for all individuals with diabetes, regardless of age, race/ethnicity, level of education, or duration of diabetes (all P <0.01).
Statin use increased significantly over time, with 4.2% taking a statin in 1988–1994, 28.8% in 1999–2002, 44.1% in 2003–2006, and 51.4% in 2007–2010 (P <0.01 for all estimates compared with 2007–2010).
All 3 goals
In 2007–2010, 18.8% of people achieved all 3 goals. Non-Hispanic whites met all 3 goals more often than did Mexican Americans and all Hispanics. Those who took a combination of insulin and oral medication were more likely to achieve all 3 goals compared with individuals taking no medication for diabetes (all P <0.05).
Achieving all 3 goals significantly improved between 1988–1994 (1.7%) and 2007–2010 (18.8%) and between 1999–2002 (7.1%) and 2007– 2010 (18.8%; all P <0.01).
Despite the dramatic increases over time in the proportion of patients meeting individual goals, almost half of Americans with diabetes did not meet each goal, and 81.2% did not achieve all 3 goals, the authors note. “The greatest potential to reduce type 2 diabetes-related complications may lie in focusing on controlling A1C, blood pressure, and LDL collectively,” they write, citing evidence from the UK Prospective Diabetes Study and Steno-2.