Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018.

Importance Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. Objective To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. Design, Setting, and Participants Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. Exposures Survey cycle. Main Outcomes and Measures Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. Results Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). Conclusions and Relevance Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

[1]  M. Chin,et al.  Social Determinants of Health and Diabetes: A Scientific Review , 2020, Diabetes care.

[2]  G. Filippatos,et al.  2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. , 2020, European heart journal.

[3]  S. Saydah,et al.  Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016. , 2019, JAMA.

[4]  F. Cosentino,et al.  The 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. , 2019, European heart journal.

[5]  C. Ogden,et al.  Mean Body Weight, Height, Waist Circumference, and Body Mass Index Among Adults: United States, 1999-2000 Through 2015-2016. , 2018, National health statistics reports.

[6]  Mohammad Hosein Farzaei,et al.  Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 , 2018, Lancet.

[7]  J. Williamson,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Circulation.

[8]  T. Einarson,et al.  Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 , 2018, Cardiovascular Diabetology.

[9]  L. Geiss,et al.  Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data , 2018, The Lancet.

[10]  Jackson T. Wright,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Journal of the American College of Cardiology.

[11]  Ping Zhang,et al.  Economic Costs of Diabetes in the U.S. in 2017 , 2018, Diabetes Care.

[12]  H. Pattison,et al.  Type 2 diabetes in adolescents and young adults. , 2018, The lancet. Diabetes & endocrinology.

[13]  11. Older Adults: Standards of Medical Care in Diabetes—2018 , 2017, Diabetes Care.

[14]  2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018 , 2017, Diabetes Care.

[15]  9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2018 , 2017, Diabetes Care.

[16]  6. Glycemic Targets: Standards of Medical Care in Diabetes—2018 , 2017, Diabetes Care.

[17]  P. Whelton,et al.  Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis , 2017, JAMA cardiology.

[18]  N. Laiteerapong,et al.  The Affordable Care Act and Diabetes Diagnosis and Care: Exploring the Potential Impacts , 2016, Current Diabetes Reports.

[19]  L. Geiss,et al.  Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. , 2015, JAMA.

[20]  M. Rahbar,et al.  Undiagnosed Diabetes and Pre-Diabetes in Health Disparities , 2015, PloS one.

[21]  S. Saydah,et al.  The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 , 2013, Diabetes Care.

[22]  J. Saaddine,et al.  Achievement of goals in U.S. diabetes care, 1999-2010. , 2013, The New England journal of medicine.

[23]  C. Schmid,et al.  A new equation to estimate glomerular filtration rate. , 2009, Annals of internal medicine.

[24]  D. Williamson,et al.  The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976-2004. , 2007, Preventive medicine.

[25]  Ciprian M Crainiceanu,et al.  Short-term variability in measures of glycemia and implications for the classification of diabetes. , 2007, Archives of internal medicine.

[26]  Edward J Boyko,et al.  The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System. , 2005, Health services research.

[27]  Y. Jang,et al.  Standards of Medical Care in Diabetes-2010 by the American Diabetes Association: Prevention and Management of Cardiovascular Disease , 2010 .

[28]  Betsy L Cadwell,et al.  Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S. , 2004, Diabetes care.

[29]  S. Haffner.  AMERICAN DIABETES ASSOCIATION. DYSLIPIDEMIA MANAGEMENT IN ADULTS WITH DIABETES , 2004 .

[30]  S. Haffner.  Dyslipidemia management in adults with diabetes. , 2004, Diabetes care.