US Trends in Glycemic Control, Treatment, and Comorbidity Burden in Patients With Diabetes

Abstract

This study explored trends over time in diabetes prevalence, glycemic control, and antidiabetic therapy choices among adults (18-64 years) and older adults (65 years). Factors that predict diabetes outcomes were explored. The study was cross-sectional, with data from the 1999 to 2004 National Health and Nutrition Examination Survey. The study group consisted of 1211 persons with self-reported diabetes. Other information obtained from the study included self-reported medication for diabetes, hypertension, stroke, heart failure, and health status. The survey also provided examination or laboratory tests of obesity, nephropathy, and glycosylated hemoglobin level. Descriptive and logistic regression analyses were used in the study. The study showed that the proportion of diabetics with good glycemic control increased during the period from 1999 to 2004. However, nearly half of the adults and one third of older adults with diabetes did not reach glycemic control in [2003][2004]. Overall, 59% of adults and 46% of older adults were obese. There was a high prevalence of hypertension, heart failure, stroke, and nephropathy among patients with diabetes, especially in older adults. The results indicate a high percentage of poor glycemic control among persons with diabetes. There were also a substantial number of comorbid conditions associated with diabetes. J Clin Hypertens (Greenwich). 2010;12:826-832.

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

“…Our data from 2005–2006 show virtually no improvement in control for A1c, BP, and LDL-cholesterol since our earlier report based on US adults with DM in 2001–2002 (Malik et al, 2007), and further demonstrate the important gap between treatment recommendations and goal achievement, with the situation dramatically worse among more severe persons with diabetes relying on insulin use. Earlier reports also document similarly poor achievement of glycemic, BP, and lipid goals (Imperatore et al, 2004; Saydah et al, 2003), as well as a high burden of comorbidities, particularly in older persons (Shaya et al, 2010). Our results are comparable with those from other studies.…”

“…Only a small proportion are at goal for recommended levels of A1c, blood pressure (BP), and lipids (Bertoni et al, 2008; Cheung et al, 2009; Imperatore, Cadwell, & Geiss, 2004; Kemp et al, 2005; Malik, Lopez, Chen, Wu, & Wong, 2007; Saydah, Fradkin, & Cowie, 2003; Shaya et al, 2010). Notably, studies of large cohorts show one-tenth or fewer persons with DM to be at goal for A1c, BP, and LDL-cholesterol (LDL-C) (Bertoni et al, 2008; Cheung et al, 2009; Kemp et al, 2005; Malik et al, 2007).…”

Determinants of successful glycemic control among participants in the BARI 2D Trial: A Post-hoc Analysis

“…Maintaining an HbA1c <7.0%, provided that it can be safely achieved, is deemed important in prevention of complications of diabetes (1-3). However, close to half of the patients with T2DM continue to have HbA1c levels of >7.0% (4). Glycemic control varies among geographic locations and racial/ethnic groups, and is influenced by obesity, dyslipidemia, duration of diabetes, basal HbA1c, and type of medication used (5-7).…”

Incident depression increases medical utilization in Medicaid patients with hypertension

“…This study was conducted using data on hypertensive patients from a contemporary Medicaid population in a single U.S. state, thus all study patients were by definition from a relatively homogeneous socioeconomic group and had the same insurance coverage, with presumably equal chance to access medical care, medication therapy or hospital services. In prior studies we had also shown a high burden of comorbidity in this population, typically underrepresented in clinical trials [45,46].…”