Trends in the control of risk factors for cardiovascular disease among adults with diagnosed diabetes: Findings from the National Health and Nutrition Examination Survey 1999-2008

Background: The aim of the present study was to examine trends in the control of key risk factors for cardiovascular disease among adults with diagnosed diabetes in the US from 1999 to 2008. Methods: Data for up to 2623 adults aged 20 years with diagnosed diabetes who participated in 2-year cycles of the National Health and Nutrition Examination Surveys from 1999 to 2008 were examined. Results: Significant improvements were seen in the control of HbA1c (37.0%-55.2%), blood pressure (35.2%-51.0%), and low-density lipoprotein-cholesterol (LDL-C; 32.5%-52.9%). Both men and women experienced significant improvement in HbA1c and LDL-C. Whites showed significant improvement in glycemic control, LDL-C control, and the control of all three risk factors. African Americans showed significant improvement in glycemic control and blood pressure control, and Mexican Americans showed significant improvement in glycemic control and the control of all three risk factors. Compared with Whites, African Americans (prevalence ratio [PR] = 0.84; 95% confidence interval [CI] 0.74-0.96) and Mexican Americans (PR = 0.82; 95% CI 0.72-0.92) had worse glycemic control, and Mexican Americans had worse control of LDL-C (PR = 0.70; 95% CI 0.57-0.87) and of all three risk factors (PR = 0.46; 95% CI 0.23-0.90). There was little change in the prevalence of not currently smoking, having C-reactive protein < 3 g/L, and having a urinary albumin: creatinine ratio < 30 mg/g. The prevalence of body mass index < 30 kg/m(2) decreased from 45.4% to 37.6% (P-linear trend = 0.045). Conclusions: Significant improvements in recommended levels of HbA1c, blood pressure, and LDL-C occurred in diabetic adults in the US between 1999 and 2008.