Control of Cardiovascular Risk Factors Among US Adults With Type 2 Diabetes With and Without Cardiovascular Disease

Abstract

Cardiovascular disease (CVD) remains leading cause of death among adults with type 2 diabetes (T2DM). There is a lack of recent national data on attainment of single and multiple CVD risk factor targets among adults with T2DM with and without CVD. We identified 1179 T2DM adults (projected to 19.7 million in the US population) aged ≥18 years from the US National Health and Nutrition Examination Survey (NHANES) 2013-2016 and examined those at target for hemoglobin A1c (HbA1c <7.0%, <8.0% if CVD), blood pressure (BP <130/80 mm Hg), low-density lipoprotein cholesterol (LDL-C <100 mg/dL non-CVD and LDL-C <70 mg/dL CVD), nonsmoking status, and body mass index (BMI <30 kg/m²and BMI <25 kg/m²) individually and as a composite in those with versus without prior CVD. Overall, around half of T2DM adults were at target control of HbA1c (55.8%), BP (51.3%), LDL-C (49.3%), with more being nonsmokers (84.3%). The proportion at target for these factors was slightly higher among those with CVD except for LDL-C. BMI was least frequently at target control (9.1% for BMI <25 kg/m²) compared to other risk factors. Moreover, only 17.3% of T2DM patients reached composite target control of HbA1c, BP and LDL-C, with 16.0% reaching target control when nonsmoking status was included and <10% if we included BMI targets. The proportion of patients at composite control was lower in those with versus without with prior CVD. Less than one-fifth adults with T2DM are at composite CVD risk factor control for HbA1c, BP, LDL-C, and nonsmoking status.