Trends in utilization of lipid- and blood pressure-lowering agents and goal attainment among the U.S. diabetic population, 1999-2008

Abstract

Background: For patients with diabetes, clinical practice guidelines recommend treating to a low-density lipoprotein cholesterol (LDL-C) goal of < 2.59 mmol/L (100 mg/dL) and a blood pressure (BP) target of <130/80 mmHg. This analysis assessed recent trends in the utilization of lipid-lowering and BP-lowering agents, as well as LDL-C and BP goal attainment, in the U.S. adult diabetic population.

Methods: 9,167 men and nonpregnant women aged ≥ 20 years were identified from the fasting subsample of the 1999-2008 National Health and Nutritional Examination Survey. Diabetes was identified in 1,214 participants by self report, self-reported use of insulin or oral medications for diabetes, or fasting glucose ≥ 6.99 mmol/L (126 mg/dL).

Results: The prevalence of diagnosed or undiagnosed diabetes increased significantly over the past decade, from 7.4% in 1999-2000 to 11.9% in 2007-2008 (P = 0.0007). During this period, the use of lipid-lowering agents by participants with diabetes increased from 19.5% to 42.2% (P < 0.0001), and the proportion at LDL-C goal increased from 29.7% to 54.4% (P < 0.0001). Although there was a significant increase in antihypertensive medication use (from 35.4% to 58.9%; P < 0.0001), there was no significant change in the proportion of participants at BP goal (from 47.6% to 55.1%; P = 0.1333) or prevalence of hypertension (from 66.6% to 74.2%; P = 0.3724).

Conclusions: The proportion of diabetic individuals taking lipid- and BP-lowering agents has increased significantly in recent years. However, while there has been a significant improvement in LDL-C goal attainment, nearly one-half of all U.S. adults with diabetes are not at recommended LDL-C or BP treatment goals.

Figure 1

Prevalence of diabetes in NHANES, 1999-2008. Diabetes was identified by self report, self-reported use of insulin or oral medications for diabetes, or fasting glucose ≥6.99 mmol/L (126 mg/dL).

Figure 2

Lipid and BP Goal Attainment in NHANES participants with diabetes, 1999-2008. A: Proportion of participants at LDL-C goal <2.59 mmol/L (100 mg/dL). B: Proportion of participants with CVD history at LDL-C goal <1.81 mmol/L (70 mg/dL). CVD was identified by self report of CHD, congestive heart failure, or stroke; CHD was identified by self report of heart disease, angina, or myocardial infarction. C: Proportion of participants at HDL-C goal >1.04 mmol/L (40 mg/dL, in males, "M") or >1.30 mmol/L (50 mg/dL, in females, "F"). D: Proportion of participants at non-HDL-C goal <3.37 mmol/L (130 mg/dL). E: Proportion of participants at BP goal ≤130/80 mmHg. F: Dual LDL-C (<2.59 mmol/L [100 mg/dL]) and BP (≤130/80 mmHg) goal attainment. To convert total cholesterol, LDL-C, HDL-C, and non-HDL-C from mg/dL to mmol/L, multiply by 0.0259.