Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018

Abstract

Background: Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning.

Methods: We conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018.

Results: Diabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007-2010 period and the 2015-2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non-high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007-2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015-2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011-2014 to 2015-2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015-2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure-lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control.

Conclusions: After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off. (Funded by the National Heart, Lung, and Blood Institute.).

Figure 1.. Prevalence of Glycemic, Blood-Pressure, and Lipid Control among Adult NHANES Participants with Diagnosed Diabetes, 1999–2002 to 2015–2018.

Shaded areas indicate 95% confidence intervals. To convert the value for non–high-density lipoprotein (non-HDL) cholesterol to millimoles per liter, multiply by 0.02586. NHANES denotes the National Health and Nutrition Examination Survey.

Figure 2.. Medication Use in Adult NHANES Participants with Diabetes, 1999–2002 to 2015–2018.

Shaded areas indicate 95% confidence intervals. ACE denotes angiotensin-converting enzyme, ARB angiotensin-receptor blocker, DPP-4 dipeptidyl peptidase 4, GLP-1 glucagon-like peptide 1, SGLT2 sodium–glucose cotransporter 2, Sulf sulfonylurea, and TZD thiazolidinedione.

Figure 3.. Distribution of the Number of Glucose-Lowering and Blood-Pressure–Lowering Medications Used in Adult NHANES Participants with Diagnosed Diabetes, 1999–2002 to 2015–2018.

Panel A shows the distribution of the number of glucose-lowering medications used by adults with diabetes, overall and according to status with respect to glycemic control. Panel B shows the distribution of the number of blood-pressure–lowering medications used by adults with diabetes, overall and according to status with respect to blood-pressure control.