Advertisement

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

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cowie C.C.
        • Rust K.F.
        • Byrd-Holt D.D.
        • et al.
        Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999-2002.
        Diabetes Care. 2006; 29: 1263-1268
        • Saydah S.H.
        • Fradkin J.
        • Cowie C.C.
        Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes.
        JAMA. 2004; 291: 335-342
        • Ong K.L.
        • Cheung B.M.
        • Wong L.Y.
        • et al.
        Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999-2004.
        Ann Epidemiol. 2008; 18: 222-229
        • The Diabetes Control and Complications Trial Research Group
        The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
        N Engl J Med. 1993; 329: 977-986
        • Patel A.
        • MacMahon S.
        • Chalmers J.
        • et al.
        • ADVANCE Collaborative Group
        Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
        N Engl J Med. 2008; 358: 2560-2572
        • UK Prospective Diabetes Study Group
        Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
        BMJ. 1998; 317: 703-713
        • Gross J.L.
        • de Azevedo M.J.
        • Silveiro S.P.
        • et al.
        Diabetic nephropathy: diagnosis, prevention, and treatment.
        Diabetes Care. 2005; 28: 164-176
        • Cheung B.M.
        Statins for people with diabetes.
        Lancet. 2008; 371: 94-95
        • Colhoun H.M.
        • Betteridge D.J.
        • Durrington P.N.
        • et al.
        Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.
        Lancet. 2004; 364: 685-696
        • Howard B.V.
        • Roman M.J.
        • Devereux R.B.
        • et al.
        Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial.
        JAMA. 2008; 299: 1678-1689
        • American Diabetes Association
        Standards of Medical Care in Diabetes-2008.
        Diabetes Care. 2008; 31: S12-S54
        • Koro C.E.
        • Bowlin S.J.
        • Bourgeois N.
        • et al.
        Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report.
        Diabetes Care. 2004; 27: 17-20
        • Hoerger T.J.
        • Segel J.E.
        • Gregg E.W.
        • et al.
        Is glycemic control improving in U.S. adults?.
        Diabetes Care. 2008; 31: 81-86
        • Saaddine J.B.
        • Cadwell B.
        • Gregg E.W.
        • et al.
        Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002.
        Ann Intern Med. 2006; 144: 465-474
        • Centers for Disease Control and Prevention
        • National Center for Health Statistics
        National Health and Nutrition Examination Survey data sets and related documentation (Survey Questionnaire, Examination and Laboratory Protocols, 1999-2006).
        (Accessed July 9, 2008.)
      1. The National Health and Nutrition Examination Survey (NHANES) Analytic and Reporting Guidelines.
        (Accessed July 9, 2008.)
        • Koopman R.J.
        • Mainous 3rd, A.G.
        • Diaz V.A.
        • et al.
        Changes in age at diagnosis of type 2 diabetes mellitus in the United States, 1988 to 2000.
        Ann Fam Med. 2005; 3: 60-63
        • Perloff D.
        • Grim C.
        • Flack J.
        • et al.
        Human blood pressure determination by sphygmomanometry.
        Circulation. 1993; 88: 2460-2470
        • National Cholesterol Education Program
        Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Hanak V.
        • Munoz J.
        • Teague J.
        • et al.
        Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B.
        Am J Cardiol. 2004; 94: 219-222
        • Bhalodkar N.C.
        • Blum S.
        • Enas E.A.
        Accuracy of the ratio of triglycerides to high-density lipoprotein cholesterol for predicting low-density lipoprotein cholesterol particle sizes, phenotype B, and particle concentrations among Asian Indians.
        Am J Cardiol. 2006; 97: 1007-1009
        • Klein R.J.
        • Schoenborn C.A.
        Age adjustment using the 2000 projected US population.
        Healthy People 2010 Stat Notes. 2001; 20: 1-10
        • Hennekens C.H.
        • Buring J.E.
        Epidemiology in Medicine.
        1st ed. Little, Brown, and Co, Boston1987
        • Ong K.L.
        • Cheung B.M.
        • Man Y.B.
        • et al.
        Treatment and control of diabetes mellitus in the United States National Health and Nutrition Examination Survey 1999-2002.
        J Cardiometabolic Synd. 2006; 1: 301-307
        • American Diabetes Association
        Standards of medical care for patients with diabetes mellitus.
        Diabetes Care. 1998; 21: S23-S31
        • American Diabetes Association
        Standards of medical care for patients with diabetes mellitus.
        Diabetes Care. 2001; 24: S33-S43
        • Elte J.W.
        • Blickle J.F.
        Thiazolidinediones for the treatment of type 2 diabetes.
        Eur J Intern Med. 2007; 18: 18-25
        • National Heart, Lung, and Blood Institute
        • United States National Institutes of Health
        ACCORD Blood Sugar Treatment Strategy Announcement.
        (February 6, 2008) (Accessed July 9, 2008.)
        • Hoenig M.R.
        Implications of the obesity epidemic for lipid-lowering therapy: non-HDL cholesterol should replace LDL cholesterol as the primary therapeutic target.
        Vasc Health Risk Manag. 2008; 4: 143-156
        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • et al.
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
        • Hansel B.
        • Kontush A.
        • Giral P.
        • et al.
        One third of the variability in HDL-cholesterol level in a large dyslipidaemic population is predicted by age, sex, and triglyceridaemia: The Paris La Pitie Study.
        Curr Med Res Opin. 2006; 22: 1149-1160
        • Kearney P.M.
        • Blackwell L.
        • Collins R.
        • et al.
        • Cholesterol Treatment Trialists' (CTT) Collaborators
        Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis.
        Lancet. 2008; 371: 117-125
        • Gaede P.
        • Vedel P.
        • Larsen N.
        • et al.
        Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
        N Engl J Med. 2003; 348: 383-393
        • Gaede P.
        • Lund-Andersen H.
        • Parving H.H.
        • et al.
        Effect of a multifactorial intervention on mortality in type 2 diabetes.
        N Engl J Med. 2008; 358: 580-591
        • Resnick H.E.
        • Foster G.L.
        • Bardsley J.
        • et al.
        Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999-2002: the National Health and Nutrition Examination Survey.
        Diabetes Care. 2006; 29: 531-537
        • Harris M.I.
        • Eastman R.C.
        • Cowie C.C.
        • et al.
        Racial and ethnic differences in glycemic control of adults with type 2 diabetes.
        Diabetes Care. 1999; 22: 403-408
        • Reed M.
        An update on Americans' access to prescription drugs.
        Issue Brief Cent Stud Health Syst Change. 2005; 95: 1-4
        • Perkins J.M.
        • Davis S.N.
        The renin-angiotensin-aldosterone system: a pivotal role in insulin sensitivity and glycemic control.
        Curr Opin Endocrinol Diabetes Obes. 2008; 15: 147-152
        • Abuissa H.
        • Jones P.G.
        • Marso S.P.
        • et al.
        Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for prevention of type 2 diabetes: a meta-analysis of randomized clinical trials.
        J Am Coll Cardiol. 2005; 46: 821-826
        • American Diabetes Association
        Economic costs of diabetes in the U.S. In 2007.
        Diabetes Care. 2008; 31: 596-615