Trends in Diabetes Management Among US Adults: 1999-2016

Abstract

Background: Updating national trends in diabetes management is important for identifying areas of progress and remaining gaps in diabetes care.

Objective: Evaluate trends in diabetes management.

Design: Three nationally representative, serial cross-sectional surveys (National Health and Nutrition Examination Survey [n = 5800], National Health Interview Survey [n = 48,519], and Behavioral Risk Factor Surveillance System [n = 741,497]) were used to estimate trends in diabetes management from 1999 to 2016.

Participants: Non-pregnant US adults (aged ≥ 18 years) diagnosed with diabetes.

Main measures: American Diabetes Association's general recommendations for glycemic and cardiovascular risk factor control, medication usage, physical activity, preventive practices, and dietary intake.

Key results: From 1999 to 2016, the proportion of US adults with diabetes who attained glycemic control (HbA1c < 7.0%) followed a quadratic trend (49.6% in 1999-2004 to 58.6% in 2005-2010 to 55.8% in 2011-2016, P < 0.05 for trend). Control of blood pressure (< 140/90 mmHg) and lipids (LDL cholesterol < 100 mg/dl) increased by 6.6 and 18.7 percentage points, respectively (P < 0.05 for trends). The proportion that attained glycemic, blood pressure, and lipid control followed a quadratic trend (13.3% in 1999-2004 to 24.8% in 2005-2010 to 20.2% in 2011-2016, P < 0.05 for trend). Use of antidiabetic, antihypertensive, and statin medication among those who were eligible rose by 8.6, 5.0, and 24.0 percentage points, respectively (P < 0.05 for trends). Aerobic inactivity declined 7.1 percentage points, while adherence to aerobic activity (≥ 150 min/week) and resistance training (≥ 2 times/week) recommendations grew 3.4 and 3.2 percentage points, respectively (P < 0.05 for trends). Engagement in preventive practices (e.g., receipt of vaccinations) consistently increased for 6 out of 8 outcomes. However, the adherence to saturated fat (< 10% of total daily calories) and sodium (< 2300 mg/day) recommendations fell by 6.5 and 5.2 percentage points (P < 0.05 for trends).

Conclusions: Despite notable improvements, declines in glycemic control and adherence to dietary recommendations may be growing challenges in diabetes care.

Keywords: diabetes mellitus; risk factor control; social disparities.

Figure 1

Mean glycated hemoglobin, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure among US adults with diagnosed diabetes, 1999–2016. This figure shows mean HbA1c (top left), LDL cholesterol (top right), systolic blood pressure (bottom left), and diastolic blood pressure (bottom right) for US adults with diagnosed diabetes at three consecutive time periods (1999–2004, 2005–2010, and 2011–2016). Estimates are weighted and come from pooled data using the National Health and Nutrition Examination Study. P values are for linear regression models where data was unpooled and time was entered as a linear and quadratic term, respectively. Estimates for LDL cholesterol levels were derived from a random subsample of fasting respondents using Friedewald’s formula.