Researchers looked at data collected as part of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 to look at trends in diabetes treatment and control, including blood glucose control. They found that diabetes control broadly improved between 1999 and the early 2010s — but then this improvement stalled and reversed into a decline. Between two different three-year periods — 2007-2010 and 2015-2018 — the proportion of study participants with diabetes who had an A1C level (a measure of long-term blood glucose control) below 7% dropped from 57.4% to 50.5%.
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Blood sugar control worsened, cholesterol control improved
Control of blood lipid (cholesterol and triglyceride) levels, though, seems to have improved slightly in people with diabetes. Using a non-HDL (high-density lipoprotein, or “good”) cholesterol level below 130 mg/dl as the standard for good lipid control, the percentage of people with good control increased from 52.3% in 2011-2014 to 55.7% in 2015-2018. But blood pressure control got worse during the same period, with the percentage of people with diabetes who achieved a level below 140/90 mmHg dropping from 74.2% in 2011-2014 to 70.4% in 2015-2018. The proportion of people with diabetes who reached all three target levels — for A1C, cholesterol, and blood pressure — rose from 9.0% in 1999-2002 to 24.9% in 200-–2010, before falling again slightly to 22.2% in 2015-2018.
The study also points to some potential reasons why diabetes control has stagnated or gotten worse in different areas since 2010. After 2010, the proportion of people with diabetes who took any glucose-lowering or blood-pressure-lowering drug stayed roughly the same, after increasing in previous years. The use of cholesterol-lowering statin drugs also levels off after 2014, which makes the improvement seen through 2018 quite remarkable. And after 2010, the use of combination drug therapy for uncontrolled blood pressure actually went down, while the use of combination therapy for uncontrolled blood glucose leveled off. The study authors speculate that some doctors may have backed off from more intensive blood glucose control after a couple of large studies showed limited cardiovascular benefits from doing so — and that this caution may be having damaging effects.
“These trends are a wake-up call, since they mean that millions of Americans with diabetes are at higher risk for major complications,” said study author Michael Fang, PhD, a postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health, in a press release. “Our study suggests that worsening control of diabetes may already be having a detrimental effect at the national level.”
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