Diabetes care in the US has failed to improve since 2005, according to the results of a study published in JAMA Internal Medicine.
In this national cross-sectional study, researchers examined patients from the 2005-2016 National Health and Nutrition Examination Survey. They aggregated data on 1,742 nonpregnant US adults diagnosed with diabetes and 746 patients undiagnosed with diabetes aged 18 years and older with diabetes who had reported fasting for at least nine months. Age, sex, race/ethnicity, health insurance, and education level were assessed over four different time intervals (2005-2008, 2009-2012, and 2013-2016), using logistic regression models predicting odds of target achievement. The study’s primary endpoints were defined as the proportion of participants overall and stratified by age, sex, and race/ethnicity who were linked to diabetes care and who met glycemic, blood pressure, cholesterol level, and smoking abstinence targets. The researchers analyzed data between August 1, 2018 and May 10, 2019.
No Discernible Change
According to the study results, between 2013-2016, 94% (95% CI, 92%-96%) of patients were linked to diabetes care, and 64% (95% CI, 58%-69%) met hemoglobin A1c level, 70% (95% CI, 64%-75%) met blood pressure level, and 57% (95% CI, 51%-62%) met cholesterol level targets. Moreover, 85% were nonsmokers (95% CI, 82% to 88%); and 23% (95% CI, 17% to 29%) achieved the composite goal. The study results were similar in 2005-2008 (composite 23%) and in 2009-2012 (composite 25%). Overall, there was no notable improvement in diabetes diagnosis or target achievement during the study period.
Moreover, when juxtaposed with middle-aged adults (45-64 years) with diagnosed diabetes, older patients (≥65 years) had higher odds (OR=1.70; 95% CI, 1.17 to 2.48) and younger adults (18-44 years) had lower odds (OR=0.53; 95% CI, 0.29 to 0.97) of meeting the composite target. Women patients had lower odds of achieving the composite target than men (OR=0.60; 95% CI, 0.45 to 0.80). Non-Hispanic black individual’s vs non-Hispanic white individuals had lower odds of achieving the composite target (OR=0.57; 95% CI, 0.39 to 0.83). Having health insurance was the strongest indicator of diabetes care (OR=3.96; 95% CI, 2.34 to 6.69).
How little we have progressed in the care of patients with #diabetes over a long period of timehttps://t.co/vqmUGuzrEn @JAMAInternalMed by @KazemianPooyan and colleagues @MGHMedicine @MGH_RI pic.twitter.com/ozQp45okox
— Eric Topol (@EricTopol) August 12, 2019
“It appears that the diabetes care cascade in the United States has not significantly improved between 2005 and 2016,” the researchers wrote. “This study’s findings suggest that gaps in diabetes care that were present in 2005, particularly among younger adults (18-44 years), women, and nonwhite individuals, persist.”
They added that “treatment advances in diabetes can meaningfully improve outcomes only if they effectively reach the populations at risk.”
Advances in #diabetes care over the past decade have not translated into meaningful improvement in population-level treatment outcomes & gaps in achieving diabetes care targets, particularly among young (18-44 years), female, & nonwhite adults, persisted during the study period. https://t.co/BqHWn22JFN
— Heidi Creighton (@HeidiCreighton) August 12, 2019
Very interesting. Diabetes control depends on controlling multiple parameters and that's where the challenge is. Is this more of social determinant problem more than medication problem? Insurance, nutrition, treatment adherence is so important. https://t.co/ishoz23qYF
— Sarika Phatak (@sarikaphatak) August 13, 2019