Comparison of demographic factors and cardiovascular risk factor control among U.S. adults with type 2 diabetes by insulin treatment classification

Abstract

Aims Data on glucose and cardiovascular disease (CVD) risk factor control among persons with type 2 diabetes mellitus (DM) according to insulin treatment status are lacking. We examined DM control, risk factors, and comorbidities among U.S. persons according to insulin treatment status. Methods In the U.S. National Health and Nutrition Examination Surveys 2003–2006, we examined in 10,637 adults aged ≥30 with type 2 DM the extent of control of A1c, LDL-C, HDL-C, triglycerides, and blood pressure (BP) and composite goal attainment by insulin use status. Results 6.6% (n=889, projected to 14.3 million) had type 2 DM; of these, 22.9% were insulin users and 57.2% were treated only by other diabetes medications. Overall, 58.2% had an A1c<7% (53 mmol/mol) (insulin users 33.1%, non-insulin treated 66.1%, and 77.9% of those not on medication, p<0.0001). Overall, 44.2% were at a BP goal of <130/80 mmHg, 43.8% had an LDL-C<100 mg/dl (2.6 mmol/L), and 13.9% a BMI<25 kg/m2. Only 10.2% were simultaneously at A1c, LDL, and BP goals (5.4% of those on insulin). Conclusions U.S. adults with type 2 DM, especially those treated with insulin remain inadequately controlled for A1c and CVD risk factors and have a high prevalence of comorbidities.

Trend Analysis in the Prevalence of Type 2 Diabetes According to Risk Factors among Korean Adults: Based on the 2001~2009 Korean National Health and Nutrition Examination Survey Data

“…This finding concurs with recent studies which reported that blood pressure control is associated with the prevalence of diabetes [5,12,25], especially for women [26]. Also, the prevalence of diabetes for both men and women with serum triglyceride levels of≥ 135 mg/dL appears to have increased more rapidly than for men and women with a triglyceride level of <135 mg/dL.…”

Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial

“…The difficulty of attaining the triple endpoint goal, with its potential metabolic improvements, in patients with type 2 diabetes is well documented, 11,12 so this substantial improvement 2 years after gastric bypass surgery is encouraging. The ADA triple endpoint is aimed at treating the key attributes of the metabolic disturbance of diabetes, with the goal of reducing risk of macrovascular and microvascular complications.…”

“…Achievement of triple endpoint control has proved remarkably difficult, with typical population groups reaching this goal roughly only 10% of the time. 11,12 However, in the first year of the DSS, 49% of participants randomly assigned to Roux-en-Y gastric bypass reached the triple endpoint goal compared with 19% of the participants randomly assigned to treatment with intensive lifestyle and medical management. 9 …”

Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: Comparison by prevalent cardiovascular disease status

“…In our study, T2DM was defined as any of the following: (1) a fasting glucose ≥ 6.6 mmol/L (126 mg/dL) after a 12-h fast, (2) non-fasting glucose ≥ 11.1 mmol/L (200 mg/dL), (3) use of oral anti-diabetes agents or (4) being told by a doctor they had diabetes, with the requirement of age at diagnosis of age 30 years or older, a standard for past NHANES studies involving DM. 11,13 …”

“…9 However, despite guidelines for stringent control of such risk factors, the proportion of patients managed to target is still suboptimal. 10,11 …”