More guideline-recommended diabetes care provided to older U.S. adults, not other age groups
From 2005 to 2018, the proportion of diabetes patients receiving care as recommended by the American Diabetes Association increased from 29.3% to 44.2% among those ages 65 years or older but did not change significantly for those ages 40 to 64 years (25.2% to 25.8%) or 20 to 39 years (9.9% to 26.0%).
A study of trends in the National Health and Nutrition Examination Survey (NHANES) found that care based on American Diabetes Association (ADA) guidelines has become more likely in recent years only among adults ages 65 years and older.
Researchers used 2005-2018 data from NHANES to perform serial cross-sectional analyses of 4,069 adults ages 20 years and older with diabetes (mean age, 59.9 years; 49.2% women) and determine trends over time in receipt of ADA guideline-recommended care. Patients were considered to have received guideline-recommended care in a particular year if they self-reported all of the following: having a primary doctor for diabetes and one or more visits to this doctor, HbA1c testing, an eye examination, a foot examination, and cholesterol testing. The study results were published April 16 by Diabetes Care.
Overall, the researchers found that the proportion of U.S. adults with diabetes who received ADA guideline-recommended care increased from 25.0% in 2005-2006 to 34.1% in 2017-2018 (P=0.004 for trend). However, while the proportion increased from 29.3% to 44.2% (P=0.001 for trend) among adults ages 65 years or older, it did not change significantly for adults ages 40 to 64 years (25.2% to 25.8%; P=0.457 for trend) or ages 20 to 39 years (9.9% to 26.0%; P=0.401 for trend). Those who were younger, were of lower socioeconomic status, were uninsured, were newly diagnosed with diabetes, were not taking diabetes medication, and did not have hypercholesterolemia were less likely to receive guideline-recommended care.
The authors noted that data were not available on clinician type or geographic area, that NHANES does not collect information on annual albuminuria testing, and that their study examined processes of care only. They concluded that receipt of ADA guideline-recommended care from 2005 to 2018 increased significantly only among adults with diabetes who were ages 65 years of age and older and that in 2017-2018 only one in three U.S. adults with diabetes reported receiving guideline-recommended care. They highlighted the fact that the recommended care processes were less common in younger adults, those with less severe disease, and those with socioeconomic limitations or without insurance. “Health insurance is an important modifiable determinant of receipt of care,” the authors wrote. “Improving access to health insurance may improve uptake of preventive care practices in adults with diabetes.”