Background Most patients with type 2 diabetes mellitus (T2DM) suffer from cardiovascular disease (CVD). Whether CVD risk factors have improved in those with DM with and without CVD is not established. We compared risk factor levels and goal attainment in US adults with diabetes with and without CVD. Methods We examined 2403 adults (aged ≥ 18 years) in the United States with T2DM (n = 654, 27% with CVD) across 1999–2010 using the US National Health and Nutrition Examination Survey (NHANES) and evaluated control of hemoglobin A1c (HbA1c), blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in those with DM with versus without CVD. Results The proportions controlled for HbA1c, BP and LDL-C have improved (p < 0.001) overall between 1999 and 2010, but only 24% were at goal for all three factors in 2009–2010. There were improvements in BP, triglycerides and LDL-C in those with CVD, and in those without CVD, there were also improvements in control of all parameters, although changes in mean levels of risk factors were less impressive. Conclusion Despite modest improvement over time, in most CVD risk factors, only one-fourth of those with T2DM are at goal for HbA1c, BP and LDL-C, with improvements seen in those without CVD more often than those with CVD.

Aims Data on glucose and cardiovascular disease (CVD) risk factor control among persons with type 2 diabetes mellitus (DM) according to insulin treatment status are lacking. We examined DM control, risk factors, and comorbidities among U.S. persons according to insulin treatment status. Methods In the U.S. National Health and Nutrition Examination Surveys 2003–2006, we examined in 10,637 adults aged ≥30 with type 2 DM the extent of control of A1c, LDL-C, HDL-C, triglycerides, and blood pressure (BP) and composite goal attainment by insulin use status. Results 6.6% (n=889, projected to 14.3 million) had type 2 DM; of these, 22.9% were insulin users and 57.2% were treated only by other diabetes medications. Overall, 58.2% had an A1c<7% (53 mmol/mol) (insulin users 33.1%, non-insulin treated 66.1%, and 77.9% of those not on medication, p<0.0001). Overall, 44.2% were at a BP goal of <130/80 mmHg, 43.8% had an LDL-C<100 mg/dl (2.6 mmol/L), and 13.9% a BMI<25 kg/m2. Only 10.2% were simultaneously at A1c, LDL, and BP goals (5.4% of those on insulin). Conclusions U.S. adults with type 2 DM, especially those treated with insulin remain inadequately controlled for A1c and CVD risk factors and have a high prevalence of comorbidities.

Diabetes mellitus (DM) is strongly related to an increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD) which includes CHD, stroke, heart failure, myocardial infarction and peripheral arterial disease. [1][2][3] Persons with DM without prior myocardial infarction (MI) have been observed to have a similar risk for future CHD events to those without DM but who have a prior MI 2 and total mortality is also similar in persons with prior CVD without DM as compared with those with DM without CVD. 4,5 The Third Adult Treatment Panel of the National Cholesterol Education Program designated DM as a CHD risk equivalent, thus indicating such persons for aggressive low density lipoprotein-cholesterol (LDL-C) lowering as in persons with pre-existing CHD. 6 However, a recent meta-analysis of 13 studies involving 45,108 subjects shows many of those with DM to have lower CHD event rates than persons with known CHD; those with DM without prior myocardial infarction had a 43% lower risk of developing total CHD events compared with those without DM but with a previous myocardial infarction. 3 Also, we have previously reported among persons with metabolic syndrome that a significant proportion (>30%) are at low estimated CHD risk. 7 Thus, these observations raise question as to whether DM is typically a CHD or CVD risk equivalent.Accordingly, it was of interest in this study to examine the global CVD risk associated with DM in US persons with DM. We examined the 10 year risk of total CVD in US persons with diabetes using global risk assessment equations for total CVD across gender and ethnicity, by DM type and treatment, as well as examined risk factor differences and goal attainment by global risk categories. Global cardiovascular disease risk assessment in United States adults with diabetes

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