Clinical research study
Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006

https://doi.org/10.1016/j.amjmed.2008.09.047Get rights and content

Abstract

Objective

Changes in the prevalence, treatment, and management of diabetes in the United States from 1999 to 2006 were studied using data from the National Health and Nutrition Examination Survey.

Methods

Data on 17,306 participants aged 20 years or more were analyzed. Glycemic, blood pressure, and cholesterol targets were glycosylated hemoglobin less than 7.0%, blood pressure less than 130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol less than 100 mg/dL, respectively.

Results

The prevalence of diagnosed diabetes was 6.5% from 1999 to 2002 and 7.8% from 2003 to 2006 (P < .05) and increased significantly in women, non-Hispanic whites, and obese people. Although there were no significant changes in the pattern of antidiabetic treatment, the age-adjusted percentage of people with diagnosed diabetes achieving glycemic and LDL targets increased from 43.1% to 57.1% (P < .05) and from 36.1% to 46.5% (P < .05), respectively. Glycosylated hemoglobin decreased from 7.62% to 7.15% during this period (P < .05). The age-adjusted percentage achieving all 3 targets increased insignificantly from 7.0% to 12.2%.

Conclusions

The prevalence of diagnosed diabetes increased significantly from 1999 to 2006. The proportion of people with diagnosed diabetes achieving glycemic and LDL targets also increased. However, there is a need to achieve glycemic, blood pressure, and LDL targets simultaneously.

Section snippets

Study Design

NHANES is conducted by the National Center of Health Statistics, Centers for Disease Control and Prevention,15, 16 and uses a stratified, multistage probability sampling design. African Americans, Mexican Americans, and people aged 60 years or more are over-sampled to provide more reliable estimates of these subgroups. Written informed consent is obtained from all participants.

Sample and Data Collection

Our analysis included all men and nonpregnant women aged 20 years or more with valid data on their history of diabetes

Results

Table 1 shows the prevalence of diagnosed diabetes in NHANES during the period from 1999 to 2006. We pooled the data into two 4-year periods for comparison. The crude prevalence of diagnosed diabetes increased from 6.5% during the period from 1999 to 2002 to 7.8% from 2003 to 2006. After standardization to the United States 2000 population, the age-adjusted prevalence increased from 6.6% to 7.7%. Among subgroups, the increase was significant among women, non-Hispanic whites, and obese people.

Discussion

NHANES became a continuous survey program in 1999, and the data on the first 8 years have recently become available.15 This provides a good opportunity to study trends in the prevalence and control of diabetes in two 4-year periods. Combining data from 4 consecutive years evens out sampling biases and gives estimates that are more nationally representative and reliable.16 This is the first report of the latest control rates in adults with diagnosed diabetes during the period from 1999 to 2006.

Conclusions

From 1999 to 2006, the prevalence of diagnosed diabetes increased considerably; however, there was a significant improvement in the proportion of people with diagnosed diabetes achieving glycemic and cholesterol target levels. Nevertheless, only 1 in 8 people with diagnosed diabetes was able to achieve the recommended glycemic, blood pressure, and LDL cholesterol target levels at the same time. Diabetes remains a major challenge for the health profession in the United States.

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    Funding: K. L. Ong is a recipient of a University of Hong Kong Postgraduate Fellowship (2007-2008).

    Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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