Fewer adults with diabetes in the United States have well-controlled blood sugar or blood pressure now compared to 10 years ago, a trend that should be a “wake-up call,” say the authors of a new study published today in The New England Journal of Medicine

The researchers analyzed data from five National Health and Nutrition Examination Surveys (NHANES) of Americans that were conducted in the past 20 years.

They aimed to find out how many people with diabetes met the three recommended targets of good diabetes control:

 A1c: <7%

 Blood pressure: <140/90 mm Hg

 Non-HDL cholesterol: <130 mg/dL

From 1999 to 2010, diabetes control improved, but since then, progress has stalled.

In the most recent survey, conducted from 2015 to 2018, only 22% of people with diabetes had all three measures under good control.

“Concerning Findings, a Wake-up Call”

“These trends are a wake-up call,” said the study’s lead author, Michael Fang, PhD, a postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.

“They mean that millions of Americans with diabetes are at higher risk for major complications,” he said in a statement from the university.

Complications of poorly controlled diabetes include foot amputation, kidney disease, and heart attack.

The findings are “concerning,” agreed senior study author Elizabeth Selvin, PhD, MPH, a professor in the Bloomberg School’s Department of Epidemiology.

“There has been a real decline in glycemic control from a decade ago, and overall, only a small proportion of people with diabetes are simultaneously meeting the key goals of glycemic control, blood pressure control, and control of high cholesterol,” she summarized.

Selvin suggests that two large clinical trials published in 2008 may partly explain these disturbing trends.

The ACCORD and ADVANCE trials found that treating patients with diabetes medicines to reach very low A1c targets did not lower risk for outcomes such as heart attacks and strokes.

In addition, some people who received this intensive treatment were more likely to develop hypoglycemia.

“As a result of these trials, what we may be seeing is that doctors of people with diabetes may have backed off a bit on glycemic control, with potentially damaging results,” Selvin speculated.

However, many new, safer diabetes drugs have become available since those trials, she noted, although cost is an issue.

Sources

New England Journal of Medicine: “Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018.”

Michael Fang, PhD, postdoctoral fellow, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Elizabeth Selvin, PhD, professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health