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Diabetes management stats suggest improved control

Friday February 15, 2013
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More people are meeting recommended goals in the three key markers of diabetes control, according to a study by the National Institutes of Health and the Centers for Disease Control and Prevention.

From 1988 to 2010, the number of people with diabetes who were able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2% to about 19%, according to the study, which is scheduled for publication in the journal Diabetes Care. Each measure also showed substantial improvement, with more than half of people meeting each individual goal in 2010.

The measures are A1C, blood pressure and cholesterol. When these measures fall outside healthy ranges, people are more likely to be burdened by complications of diabetes, including heart disease, stroke, kidney disease, blindness and amputation.

To gauge diabetes management, researchers analyzed data from the National Health and Nutrition Examination Surveys from 1988-1994 and 1999-2010.

"The most impressive finding was the significant improvement in diabetes management over time across all groups," Catherine Cowie, PhD, the studyís senior author and director of the Diabetes Epidemiology Program a the National Institute of Diabetes and Digestive and Kidney Diseases, the NIH branch that conducted and funded the study, said in a news release.

"However, we see a lot of room for improvement — for everyone, but particularly for younger people and some minority groups."

According to 2007-10 data on Americans with diabetes, 53% met A1C goals, compared with 43% according to 1988-94 data; 51% met blood pressure goals, up from 33%; and 56% met cholesterol goals, up substantially from 10%.

Improved cholesterol control likely was due to the increase in the use of statins from about 4% of people with diabetes in 1988-94 to 51% in 2007-10, according to the researchers.

Glucose control was worse in Mexican-Americans and in younger adults. Only 44% of Mexican-Americans met A1C goals in 2007-10, versus 53% of whites and blacks. People ages 20 to 49 were less likely to meet A1C goals than older people.

"It is particularly disturbing that good control was seen less frequently in young people," said Judith Fradkin, MD, director of the NIDDK Division of Diabetes, Endocrinology and Metabolic Diseases. "Research has shown that good diabetes control early in the course of disease has long-lasting benefits [in terms of] reducing the risk of complications. For people with long life expectancy after diagnosis of diabetes, itís especially important to focus on meeting diabetes management goals as early as possible, because with that longer life comes a greater chance of developing complications if they do not control their diabetes."

Sarah Stark Casagrande, PhD, an epidemiologist from Social & Scientific Systems Inc. in Silver Spring, Md., whose work is supported by NIDDK, noted that not only do Mexican-Americans and non-Hispanic blacks have higher rates of diabetes, but those who develop diabetes have poorer health outcomes. "While diabetes control has improved in these populations, some disparities remain, demonstrating the need for improved management of the disease to prevent its devastating complications," Casagrande said.

Goals for A1C, blood pressure, and cholesterol must be individualized for people with diabetes given that effects of diabetes can differ depending on a personís age, type of diabetes, diabetes medications, complications from diabetes and other factors, according to the report.

For A1C, a goal for many people is below 7%. People with long life expectancies particularly should have an emphasis placed on controlling A1C to protect against future eye, nerve and kidney disease. Goals can be less stringent for people with limited life expectancy because complications develop over time.

For blood pressure, the goal for most people is 130/80. Moderate- or high-dose statin therapy is recommended for people older than 40 with diabetes, with a goal of keeping low-density lipoprotein under 100 milligrams per deciliter. Control of blood pressure and cholesterol particularly are important for lowering cardiovascular risk.

The study abstract is available at http://care.diabetesjournals.org/content/early/2013/02/07/dc12-2258.abstract.


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