Trends in Receipt of American Diabetes Association Guideline-Recommended Care Among U.S. Adults With Diabetes: NHANES 2005-2018

Abstract

Objective: To characterize national trends and characteristics of adults with diabetes receiving American Diabetes Association (ADA) guideline-recommended care.

Research design and methods: We performed serial cross-sectional analyses of 4,069 adults aged ≥20 years with diabetes who participated in the 2005-2018 National Health and Nutrition Examination Survey (NHANES).

Results: Overall, the proportion of U.S. adults with diabetes receiving ADA guideline-recommended care meeting all five criteria by self-report in the past year (having a primary doctor for diabetes and one or more visits for this doctor, HbA_1c testing, an eye examination, a foot examination, and cholesterol testing) increased from 25.0% in 2005-2006 to 34.1% in 2017-2018 (P-trend = 0.004). For participants with age ≥65 years, it increased from 29.3% in 2005-2006 to 44.2% in 2017-2018 (P-trend = 0.001), whereas for participants with age 40-64 and 20-39 years, it did not change significantly during the same time period: 25.2% to 25.8% (P-trend = 0.457) and 9.9% to 26.0% (P-trend = 0.401), respectively. Those who were not receiving ADA guideline-recommended care were more likely to be younger, of lower socioeconomic status, uninsured, newly diagnosed with diabetes, not on diabetes medication, and free of hypercholesterolemia.

Conclusions: Receipt of ADA guideline-recommended care increased only among adults with diabetes aged ≥65 years in the past decade. In 2017-2018, only one of three U.S. adults with diabetes reported receiving ADA guideline-recommended care, with even a lower receipt of care among those <65 years of age. Efforts are needed to improve health care delivery and equity in diabetes care. Insurance status is an important modifiable determinant of receiving ADA guideline-recommended care.

Figure 1

Trend in receipt of ADA guideline-recommended care (all components) among U.S. adults with self-reported diabetes (NHANES 2005–2018). A: Overall participants. B: Participants stratified by age.