Half of diabetics do not meet recommended care goals

Almost half of U.S. adults with diabetes did not meet recommended goals for diabetes care, despite improvements in controlling risk factors and adhering to preventive practices from 1999 to 2010, a study concluded.

Researchers analyzed data for adults with self-reported diabetes: 3,355 people from the National Health and Nutrition Examination Survey and 97,310 from the Behavioral Risk Factor Surveillance System, from the years 1999 to 2010. Results were published by the New England Journal of Medicine on April 25.

Between the 1999-to-2002 period and the 2007-to-2010 period, the proportion of patients with a hemoglobin A1c (HbA1c) level over 9% decreased by 5.8 percentage points (95% CI, −10.5 to −1.1), while the proportion with an HbA1c under 7% increased by 7.9 percentage points (95% CI, 0.8 to 15.0). The proportion with blood pressure under 130/80 mm Hg increased by 11.7 percentage points (95% CI, 5.7 to 17.7). The proportion with LDL cholesterol level under 100 mg/dL increased by 20.8 percentage points (95% CI, 11.6 to 30.0). Still, by the later time period, only 14.3% of surveyed diabetics did not smoke and met all three targets for glycated hemoglobin, blood pressure control, and LDL cholesterol.

A comparison of data from 2000 and 2008 showed nonsignificant drops in the number of people receiving annual eye examinations and dental exams. However, more people received annual checks of lipid levels, annual foot examinations, annual influenza vaccinations, pneumococcal vaccination, at least daily self-monitoring of glucose, diabetes education at diagnosis, or angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers.

In 2007-2010, more than 73.4% of participants underwent annual eye examinations, 71.4% underwent foot examinations, 88.2% underwent lipid checks and 70.9% performed self-monitoring of glucose levels. Also, 49% to 60% reported receiving vaccinations and 54.6% reported receiving diabetes education. However, only 22.4% of diabetics underwent annual influenza vaccination, and had both eye and foot examinations in 2008.

The researchers wrote, “We noted that younger adults were less likely than older adults to meet goals for treatment and preventive practices; furthermore, younger adults had no significant improvements in these areas over time. It is unclear whether physician inattentiveness, poor access to health care, or other factors account for these gaps. Because early control of the risk factors for microvascular and macrovascular disease may confer benefits, these results suggest that younger adults with diabetes need further attention.”