Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Abstract

IMPORTANCEUnderstanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES Survey cycle.MAIN OUTCOMES AND MEASURES Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A 1c (HbA 1c ) level of 6.5% or more. Three risk factor control goals were individualized HbA 1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA 1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA 1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults Ն65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). CONCLUSIONS AND RELEVANCEBased on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

Sociodemographic, Clinical, and Treatment-Related Factors Associated With Hyperglycemic Crises Among Adults With Type 1 or Type 2 Diabetes in the US From 2014 to 2020

“…We found that the rates of hyperglycemic crises increased over time among patients with type 1 diabetes, from 43.30 per 1000 person-years in 2014 to 61.36 per 1000 person-years in 2019, consistent with previously described trends through 2015 16 and recent population-level data showing an overall worsening of glycemic control among patients with diabetes in the US. 23 , 24 There was no comparable temporal change in hyperglycemic crises rates among patients with type 2 diabetes. This persistent rise in rates of hyperglycemic crises among patients with type 1 diabetes underscores the urgency of improving glycemic control and diabetes management in this population.…”

Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury

“…According to the International Diabetes Federation Atlas, 9th edition, 463 million adults worldwide live with diabetes as of 2019, with a prevalence rate of approximately 9.3% and an average annual growth rate of 51% ( 1 ). Diabetes easily leads to several complications that affect the prognosis of patients with diabetes ( 2 , 3 ). Approximately 4.2 million people worldwide died from diabetes or its complications in 2019, accounting for approximately 11.3% of all-cause deaths worldwide ( 1 ).…”

Temporal Trends in Renal Replacement Therapy in Community-Based People with or without Type 2 Diabetes: The Fremantle Diabetes Study

“…Several longitudinal studies from North America, Europe, Asia and Australia have demonstrated that there has been a decline in chronic macrovascular complications of diabetes over the past few decades [1][2][3][4] as well as in all-cause and cardiovascular disease (CVD) death [5,6], reflecting improving CVD risk factor management [7][8][9]. Although these encouraging trends may be stabilizing and even reversing based on even more recent US data [10,11], there is still the possibility that other complications such as chronic kidney disease (CKD) may become more prominent as longevity increases [12].…”