U.S. Diabetes Care Has Not Improved in the Past Decade

A study published in JAMA Internal Medicine found that U.S. diabetes care has not improved between 2005 and 2016, with gaps in achieving diabetes care targets particularly observed in young (aged 18-44 years), female, and non-white adults.

Researchers evaluated data from the National Health and Nutrition Examination Survey and included 2,488 non-pregnant U.S. adults with diabetes who had reported fasting for nine or more hours: 1,742 were diagnosed with diabetes and 746 had undiagnosed diabetes.

From 2013 to 2016, 94% of those with diagnosed diabetes (95% confidence interval [CI], 92-96) were linked to diabetes care: 64% (95% CI, 58-69) met glycated hemoglobin (HbA1C) level (per American Diabetes Association [ADA] recommendations; 7.0-8.5, depending on age and clinical status), 70% (95% CI, 64-75) met blood pressure level (also per the ADA; <140/90 mmHg), and 57% (95% CI, 51-62) met cholesterol level (<100 mg/dL) targets. Most (85%) were non-smokers (95% CI, 82-88). Just 23% of patients (95% CI, 17-29) achieved the composite goal (all targets mentioned previously).

The researchers found that composite goal results were similar in 2005 to 2008 (23%) and in 2009 to 2012 (25%). There was no significant improvement in diagnosis or target achievement during the study period.

Compared with middle-aged adults with diabetes (45-64 years), older patients (≥65 years) had higher odds (adjusted odds ratio [aOR], 1.70; 95% CI, 1.17-2.48) and younger adults (18-44 years) had lower odds (aOR, 0.53; 95% CI, 0.29-0.97) of meeting the composite target.

Women had lower odds of achieving the composite target than men (aOR, 0.60; 95% CI, 0.45-0.80), as did non-Hispanic black individuals compard with non-Hispanic white individuals (aOR, 0.57; 95% CI, 0.39-0.83).

The strongest predictor of linkage to diabetes care was health insurance (aOR, 3.96; 95% CI, 2.34-6.69).

“It appears that advances in diabetes care over the past decade have not translated into meaningful improvement in population-level treatment outcomes,” the researchers concluded.

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