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

Literature - Li Wang, Xiaoguang Li, Zhaoxin Wang et al. - JAMA. 2021 Jun 25;e219883. doi: 10.1001/jama.2021.9883.

Introduction and methods

Information on the prevalence of diabetes and risk factor control in diabetes is of importance to improve prevention efforts. This study investigated the trends in the prevalence of diabetes and control of risk factors in diabetes in the US population between 1999-2000 and 2017-2018.

The study used data from the National Health and Nutrition Examination Survey (NHANES), a continuous, nationally representative survey of the noninstitutionalized civilian resident US population. Collected data in NHANES have been released in 2-year cycles. This study included data from 10 cycles between 1999-2000 and 2017-2018. Data from 28143 participants aged ≥18 years were included (49.3% men, 68.0% non-Hispanic White, 11.3% non-Hispanic Black, 8.0% Mexican American). Pregnant women were excluded. Self-reported diabetes (diagnosed by a physician or other healthcare professional) was defined as diagnosed diabetes. Fasting plasma glucose of ≥126 mg/dL or HbA1C of ≥6.5% among individuals without diagnosed diabetes was defined as undiagnosed diabetes.

Primary outcomes were prevalence of diabetes (both diagnosed and undiagnosed diabetes) and proportion of adults with diagnosed diabetes who achieved 3 risk factor control goals (individualized HbA1C targets, BP<130/80 mmHg, and LDL-c <100 mg/dL).

Main results

• The estimated unadjusted prevalence of diabetes (diagnosed and undiagnosed) in the NHANES 2017-2018 cycle was 14.6% (95% CI, 12.8%-16.3%). The estimated unadjusted prevalence of diagnosed diabetes was 11.2% (95%CI 9.8%-12.5%) and of undiagnosed diabetes was 3.4% (95%CI 2.5-4.3%). 23.3% of adults with diabetes were undiagnosed (95%CI 18.6-28.1%).
• The estimated age-standardized prevalence of diabetes increased significantly from 1999-2000 to 2017-2018: from 9.8% (95%CI 8.6%-11.1%) to 14.3% (95%CI 12.9%-15.8%).
• The estimated age-standardized proportion of adults with diagnosed diabetes who achieved BP<130/80 mmHg and LDL-c <100 mg/dL increased significantly from 1999-2000 to 2015-2018 (P for trend = 0.007 and <0.001, respectively). There was no significant improvement from 1999-2000 to 2015-2018 in the estimated age-standardized proportion of adults with diagnosed diabetes who achieved individualized HbA1C targets (P for trend = 0.51). The proportion of individuals achieving all 3 risk factor control goals was significantly higher in 2015-2018 than in 1999-2002 (P for trend =0.01).
• Among adults with diagnosed diabetes, 66.8% (95%CI 63.2-70.4%) achieved individualized HbA1C targets, 48.2% (95%CI 44.6%-51.8%) achieved BP<130/80 mmHg, and 59.7% (95%CI 54.2%-65.2%) achieved LDL-c <100 mg/dL in 2015-2018. 21.2% of adults with diagnosed diabetes achieved all 3 risk factor control goals (95%CI 15.5%-26.8%) in 2015-2018.
• During the entire study period, the 3 risk factor control goals were less likely to be achieved by young adults aged 18-44 years compared to older adults aged ≥65 years (7.4% vs 21.7%, adjusted OR 0.32 [95%CI 0.16-0.63]), by non-Hispanic Black adults compared to non-Hispanic White adults (12.5% vs 20.6%, adjusted OR 0.60 [95%CI 0.40-0.90]), and by Mexican Americans compared to non-Hispanic White adults (10.9% vs 20.6%, adjusted OR 0.48 [95%CI 0.31-0.77]).

Conclusion

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