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. 2021 Jun 25;326(8):1-13.
doi: 10.1001/jama.2021.9883. Online ahead of print.

Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Li Wang  1 , Xiaoguang Li  1 , Zhaoxin Wang  1 , Michael P Bancks  2 , Mercedes R Carnethon  3 , Philip Greenland  3 , Ying-Qing Feng  4 , Hui Wang  1 , Victor W Zhong  1
Affiliations

Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Li Wang et al. JAMA. .

Abstract

Importance: Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease.

Objective: To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018.

Design, setting, and participants: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women.

Exposures: Survey cycle.

Main outcomes and measures: Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated.

Results: Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]).

Conclusions and relevance: Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bancks reported receiving grants from the National Institutes of Health (NIH) as a coinvestigator with multiple unrelated epidemiologic studies and clinical trials and receiving funding from the NIH for his work with these cohorts, outside the submitted work. Dr Greenland reported receiving grants from NIH and the American Heart Association, outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Trends in Prevalence of Diabetes Among US Adults
Trends in prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes (A), and percentage of diabetes that was undiagnosed (B). Diagnosed diabetes was defined according to self-report of diabetes diagnosis by a physician or other health professional. Undiagnosed diabetes was defined as having a hemoglobin A1c level of 6.5% or higher or fasting plasma glucose level of 126 mg/dL or higher among individuals without diagnosed diabetes. All estimates were age standardized to the 2017-2018 National Health and Nutrition Examination Survey (NHANES) nonpregnant adult population, using the age groups 18 to 44 years, 45 to 64 years, and 65 years or older, except for the analysis related to the percentage of diabetes that was undiagnosed. Estimates were age standardized to all diabetes cases in 2017-2018 other than during pregnancy in the NHANES, using the age groups 18 to 44 years, 45 to 64 years, and 65 years or older. A, Interview sample (28 143 participants). B, Individuals with diabetes (8493 participants). Error bars indicate 95% CIs. P for trend was obtained from joinpoint regressions: P <.001 for total and diagnosed and P = .32 for undiagnosed diabetes in panel A; P = .002 for panel B. Specific estimates are shown in Table 2 and eTables 1 to 3 in the Supplement.
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Comment in

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