Most adults with diabetes in the United States aren’t getting the care they need as recommended by the American Diabetes Association (ADA), according to a new analysis published in the journal Diabetes Care.
Researchers looked at data from 4,069 adults with diabetes, ages 20 and older, who took part in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Participants were asked, as part of the survey, whether they met each of the five main ADA recommendations for diabetes care in the last year — having one or more visits with a primary doctor for diabetes, testing for A1C (a measure of long-term blood glucose control), an eye examination, a foot examination, and testing for cholesterol. In the 2005-2006 NHANES survey, only 25.0% of participants reported meeting all five of the ADA’s recommendations — a number that rose to 34.1% in the 2017-2018 survey. This means, of course, that in the most recent survey, almost two-thirds of adults with diabetes didn’t get the care they needed as recommended by the ADA.
Majority not receiving ADA-recommended care
Older survey participants were more likely to report getting the recommended care for diabetes, with 29.3% of those ages 65 and older meeting all five recommendations in 2005-2006 and 44.2% meting them in 2017-2018. They were also the only group to see a significant improvement in the proportion of people getting recommended care between 2005-2006 and 2017-2018. For participants ages 40-64, the proportion getting recommended care barely budged from 25.2% to 25.8%, while for participants ages 20-39, there weren’t enough responses for the increase from 9.9% to 26.0% to be statistically significant. As noted in a Medscape article on the study, the only component of ADA-recommended care that increased in all age groups between the two study periods was A1C testing, which was reported by 64.4% of participants in 2005-2006 and by 85.3% of participants in 2017-2018.
During both survey periods, people who didn’t get ADA-recommended care were more likely to be younger, have a lower socioeconomic status (less income and wealth), lack health insurance, be recently diagnosed with diabetes, not take any diabetes medication, and not have high cholesterol. The researchers noted that people who fit any of these criteria may be candidates for extra attention from healthcare providers to make sure they get the diabetes care they need. A number of factors were found to be unrelated to whether people got recommended care, including sex, race and ethnicity, body-mass index (BMI, a measure of weight that takes height into account), smoking status, A1C level, and whether people had hypertension (high blood pressure), cardiovascular disease, chronic kidney disease, or symptoms of depression.
Not surprisingly, people who received ADA-recommended care were more likely to have an A1C level below 7.5% (52% more likely than those who didn’t get ADA-recommended care), to have blood pressure below 140/90 mm Hg (47% more likely), and to have LDL (low-density lipoprotein, or “bad”) cholesterol below 100 mg/dl (47% more likely). They were also 79% more likely to take a cholesterol-lowering medication.
“Efforts are needed to improve healthcare delivery and equity in diabetes care,” the researchers concluded, adding that “Insurance status is an important modifiable determinant of receiving ADA guideline-recommended care.”
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