Blood sugar control among adults with diabetes in the United States has declined significantly over the past decade, according to a national study by researchers at the Johns Hopkins Bloomberg School of Public Health. The findings highlight the ongoing challenges of controlling one of the most prevalent chronic health conditions in the country.
The researchers, whose findings will appear online on June 9 at New England Journal of Medicine, used data from an annual government-sponsored health study to analyze trends in blood sugar (or “glycemic”) control, as well as blood pressure and cholesterol control in adults with diabetes.
They found that the proportion of adults with diabetes was reaching glycemic control improved from 1999 over the next ten years, but then decreased significantly, from 57.4% during 2007-2010 to 50.5% during 2015-2018. The proportion that blood pressure control achieved was also reduced, while the proportion that cholesterol control achieved was basically stabilized.
“These are worrying findings. There has been a real decline in glycemic control for a decade and, in general, only a small proportion of people with diabetes simultaneously meet the key goals of glycemic control, blood pressure control and high cholesterol control, ”says study author Elizabeth Selvin, Ph.D., MPH, a professor in the Department of Epidemiology at Bloomberg School.
Diabetes occurs mainly in the form of type 2 diabetes, which is strongly related to diet and lifestyle factors. The disease affects more than 34 million, or 13 percent, of the U.S. adult population, according to the Centers for Disease Control and Prevention, and represents an ongoing public health crisis. By causing chronic and associated blood sugar levels high blood pressure and high cholesterol, diabetes increases the risk of other serious diseases, especially cardiovascular disease and complications, including amputation and kidney disease. The traditional “ABCs” of diabetes care are to reduce the high level of chronic blood sugar (usually measured with the A1C hemoglobin test), keep blood pressure below hypertensive levels, and control cholesterol levels.
For their study, Selvin and colleagues examined data from the U.S. Government-backed National Health and Nutrition Examination Survey, which includes interviews and clinical examinations of approximately 5,000 people in the United States. annually, to analyze recent trends in whether adults with diabetes achieved treatment goals. Her sample consisted of 6,653 survey participants from 1999 to 2018 who were at least 20 years old and not pregnant and reported that a doctor had diagnosed diabetes outside of pregnancy.
Selvin and his team found that the percentage achieving glycemic control, defined as HbA1c levels below 7.0 percent, went from 44.0 percent between 1999-2002 to 57.4 percent. between 2007-2010. This figure fell to 50.5% from 2015 to 2018.
Similarly, the percentage that achieves blood pressure control (
The percentage of people with diabetes with bad cholesterol control, defined as non-HDL cholesterol below 130 mg / dl, rose sharply from 25.3 percent in 1999-2002 to 52.3 percent in 2007-2010, but then it stagnated, reaching only 55.7 percent from 2015 to 2018.
The proportion that achieves control of the three risk factors went from 9.0 percent in the period 1999-2002 to 24.9 percent during the period 2007-2010, and then dropped to 22.2 percent between 2015 and 2018.
“These trends are a wake-up call, as they mean millions of Americans with diabetes are at higher risk for major complications,” says Michael Fang, Ph.D., a postdoctoral fellow at Bloomberg School and lead author of the study. . “Our study suggests that a worsening of diabetes control may already have a detrimental effect nationally.”
The findings suggest that something has changed in the last decade or so to reverse – or at least slow down progress – in controlling these measures of diabetes care.
Selvin points out that two major clinical trials, the results of which were published in 2008, may explain part of the new trend. The trials, known as the ACCORD and ADVANCE trials, found that intensive reduction of HbA1c to very low levels did not show the cardiovascular benefits people expected. Some participants in the trial who had their blood sugar levels at very low levels increased their risk ofblood sugar or hypoglycemia, which can be very dangerous.
“As a result of these trials, what we can see is that doctors in people with diabetes may have regressed a bit in glycemic control, with potentially harmful results,” says Selvin.
She notes that since these trials, many new and improved diabetes medications have been available. If HbA1c can be reduced with safer drugs that do not cause hypoglycemia, it will likely benefit most patients.
“Trends in the Treatment and Control of Adult Diabetes in the United States – 1999-2018” was co-authored by Michael Fang, Dan Wang, Josef Coresh, and Elizabeth Selvin.
“Trends in the Treatment and Control of Adult Diabetes in the United States – 1999-2018” New England Journal of Medicine (2021).
Citation: A major study on diabetes trends shows that U.S. blood sugar control is getting worse (2021, June 9), retrieved June 9, 2021 at https://medicalxpress.com/news/2021- 06-major-diabetes-trends-americans-blood. html
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