Trends in Diabetes Treatment and Control in US Adults, 1999-2018

被引:452
作者
Fang, Michael [1 ,2 ]
Wang, Dan [1 ,2 ]
Coresh, Josef [1 ,2 ]
Selvin, Elizabeth [1 ,2 ]
机构
[1] Johns Hopkins Bloomberg Sch Publ Hlth, Welch Ctr Prevent Epidemiol & Clin Res, 2024 E Monument St, Baltimore, MD 21287 USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, 2024 E Monument St, Baltimore, MD 21287 USA
基金
美国国家卫生研究院;
关键词
MULTIFACTORIAL INTERVENTION; CARDIOVASCULAR RISK; GLYCEMIC CONTROL; UNITED-STATES; TYPE-2; PREVALENCE; MANAGEMENT; DRUGS;
D O I
10.1056/NEJMsa2032271
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.) Diabetes Treatment and Control in U.S. Adults, 1999-2018 A cross-sectional study of U.S. adult participants with diabetes in the National Health and Nutrition Examination Survey assessed national trends in diabetes treatment and risk-factor control from 1999 through 2018. After more than a decade of progress, glycemic and blood-pressure control declined, while lipid control plateaued.
引用
收藏
页码:2219 / 2228
页数:10
相关论文
共 35 条
[1]   Achievement of Goals in U.S. Diabetes Care, 1999-2010 [J].
Ali, Mohammed K. ;
Bullard, Kai McKeever ;
Saaddine, Jinan B. ;
Cowie, Catherine C. ;
Imperatore, Giuseppina ;
Gregg, Edward W. .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (17) :1613-1624
[4]   Standards of Medical Care in Diabetes-2014 [J].
不详 .
DIABETES CARE, 2014, 37 :S14-S80
[5]  
[Anonymous], 2012, DIABETES CARE, V35, pS11, DOI [10.2337/dc35-S011, 10.2337/dc12-s004]
[6]  
[Anonymous], 2017, National diabetes statistics report: estimates of diabetes and its burden in the United States
[7]   Prevalence of Diagnosed Diabetes in Adults by Diabetes Type - United States, 2016 [J].
Bullard, Kai McKeever ;
Cowie, Catherine C. ;
Lessem, Sarah E. ;
Saydah, Sharon H. ;
Menke, Andy ;
Geiss, Linda S. ;
Orchard, Trevor J. ;
Rolka, Deborah B. ;
Imperatore, Giuseppina .
MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT, 2018, 67 (12) :359-361
[8]   Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus [J].
Cushman, William C. ;
Evans, Gregory W. ;
Byington, Robert P. ;
Goff, David C., Jr. ;
Grimm, Richard H., Jr. ;
Cutler, Jeffrey A. ;
Simons-Morton, Denise G. ;
Basile, Jan N. ;
Corson, Marshall A. ;
Probstfield, Jeffrey L. ;
Katz, Lois ;
Peterson, Kevin A. ;
Friedewald, William T. ;
Buse, John B. ;
Bigger, J. Thomas ;
Gerstein, Hertzel C. ;
Ismail-Beigi, Faramarz .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (17) :1575-1585
[9]   Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes [J].
Duckworth, William ;
Abraira, Carlos ;
Moritz, Thomas ;
Reda, Domenic ;
Emanuele, Nicholas ;
Reaven, Peter D. ;
Zieve, Franklin J. ;
Marks, Jennifer ;
Davis, Stephen N. ;
Hayward, Rodney ;
Warren, Stuart R. ;
Goldman, Steven ;
McCarren, Madeline ;
Vitek, Mary Ellen ;
Henderson, William G. ;
Huang, Grant D. .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 360 (02) :129-U62
[10]   Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes [J].
Gaede, P ;
Vedel, P ;
Larsen, N ;
Jensen, GVH ;
Parving, H ;
Pedersen, O .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (05) :383-393