Achievement of Goals in U.S. Diabetes Care, 1999–2010

Study Questions:

What are trends in risk-factor control and adherence to preventive practices among US adults with diabetes from 1999 through 2010?


This was an analysis of data from the National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS). The analysis included 3,355 adults from the NHANES who reported having received a diagnosis of diabetes from a health professional, and 97,310 adults from the BRFSS who reported having diabetes. The authors evaluated the control of single or combined risk factors for microvascular and macrovascular complications of diabetes (glycemia, blood pressure, cholesterol level, and tobacco use) and adherence to preventive practices (screenings, glucose monitoring, and vaccinations).


From 1999 through 2010, there were significant increases in the proportions of participants who met the recommended targets for glycated hemoglobin level <7.0% (7.9 percentage points; 95% confidence interval [CI], 0.8-15.0), blood pressure <130/80 mm Hg (11.7 percentage points; 95% CI, 5.7-17.7), and target level of low-density lipoprotein (LDL) cholesterol <100 mg/dl (20.8 percentage points; 95% CI, 11.6-30.0). The proportion of participants using tobacco did not change significantly (-1.7 percentage points; 95% CI, -6.2 to 2.8), and 22.3% still smoked in 2010. Though there was an increase (10.9 percentage points; 95% CI, 9.3-12.5) over the past decade in the proportion of adults with diabetes who underwent annual influenza vaccination and eye and foot examinations, only 22.4% of patients met all three criteria in 2008; 40-50% of participants did not receive diabetes education, vaccinations, or annual dental examinations.


While an analysis of data from NHANES and BRFSS demonstrated some gains over the past decade, one third to one half of US adults with diabetes were not meeting targets for glycated hemoglobin, blood pressure, or LDL cholesterol level by 2010, and nearly one quarter continued to smoke. Only 14.3% met targets for all four risk factors. Less than one quarter of patients underwent annual influenza vaccination and eye and foot examinations.


This study draws attention to important gaps in diabetes care and prevention, despite modest improvements in risk factor control and prevention from 1999 to 2010. Up to one half of patients did not meet individualized targets for glycemic control, blood pressure, or lipid control, and almost one in four patients continued to smoke, despite increased public awareness and quality improvement initiatives to improve diabetes care over the past decade. These statistics should be a call to continued action and a potential catalyst for novel ways of thinking to achieve evidence-based (or individualized) treatment targets and realize successful risk factor modification.

Keywords: Blood Pressure, Risk Factors, Glycated Hemoglobin A, Quality Improvement, Cholesterol, Smoke, Blood Glucose, Behavioral Risk Factor Surveillance System, Tobacco Use, Vaccination, Nutrition Surveys, Diabetes Mellitus

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