The number of Americans meeting their diabetes goals – blood sugar, blood pressure and cholesterol – has increased considerably over a 12-year period, says a new study by the NIH (National Institutes of Health) and CDC (Centers for Disease Control and Prevention) and published in Diabetes Care.

The authors wrote that from 1988 to 2010, the proportion of diabetes patients in the USA who exceeded or met the three measures that demonstrate good diabetes management increased from approximately 2% to 19%.

Each measure, the researchers added, showed significant improvement. By 2010, over half of all diabetes patients in the country had met each individual goal.

They are known as the ABCs of diabetes:

  • A1C test – this measures the patient’s average blood glucose control during the past two to three months. It is determined by measuring the percentage of HbA1c (glycated hemoglobin) in the blood. According to the American Diabetes Association you should “Check your A1C twice year at a minimum, or more frequently when necessary”.
  • Blood pressure
  • Cholesterol

If these three goals are not maintained within healthy ranges, the patient is more likely to develop diabetes complications, which may include blindness, kidney disease, stroke, heart disease and amputation.

Even though improvement has been considerable, the authors emphasized that the majority of patients have not met their three goals, therefore, there is still an urgent need for better diabetes control nationally. The report showed that young individuals and some minority groups were still well below the national average.

The incidences of illnesses and conditions which are known to be complications of diabetes have risen in many cases. A study carried out by researchers from Johns Hopkins University School of Medicine, Baltimore, and published in JAMA (December 2012 issue) showed that the increase in vision impairment in the USA is linked to a higher prevalence of diabetes.

Catherine Cowie, Ph.D., director of the Diabetes Epidemiology Program at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and team gathered and examined data from the National Health Nutrition Examination Surveys from 1988/94 and 1999/2010.

Dr. Cowie, who was also senior author, said:

“The most impressive finding was the significant improvement in diabetes management over time across all groups. However, we see a lot of room for improvement, for everyone, but particularly for younger people and some minority groups.”

The 2007-2010 data showed that:

  • 53% of American diabetes patients met A1C goals, compared to 43% in 1988/94. Just 44% of Mexican-Americans met A1C targets. 53% of African-Americans and American-Caucasians met the goals. Patients aged from 20 to 49 were less likely to meet their A1C goals compared to older individuals.
  • 51% met their blood pressure targets, compared to just 33% in 1988/94
  • 56% met their cholesterol targets, compared to only 10% in 1988/94. At the beginning of the study period, about 4% of patients were on statins, compared to 51% in 2007-2010. The authors believe the increase in statin usage was probably the main reason for better cholesterol control.

Judith Fradkin, M.D., director of the NIDDK Division of Diabetes, Endocrinology, and Metabolic Diseases, wrote “It is particularly disturbing that good control was seen less frequently in young people. Research has shown that good diabetes control early in the course of disease has long-lasting benefits reducing the risk of complications. For people with long life expectancy after diagnosis of diabetes, it’s especially important to focus on meeting diabetes management goals as early as possible, because with that longer life comes a greater chance of developing complications if they do not control their diabetes.”

First author, Sarah Stark Casagrande, Ph.D., an epidemiologist from Social & Scientific Systems Inc., Silver Spring, Md., whose work is supported by NIDDK, said “Not only do Mexican-Americans and non-Hispanic blacks have higher rates of diabetes, members of these groups who develop diabetes also have poorer health outcomes. While diabetes control has improved in these populations, some disparities remain, demonstrating the need for improved management of the disease to prevent its devastating complications.”

Doctors need to help diabetes patients find their own goals for cholesterol, blood pressure and A1C, because diabetes affects people in different ways, depending on their age, what type of diabetes they have, their medications, diabetes complications, and some other factors.

  • A1C – a goal of less than 7% is common for many people with diabetes. A patient with a long life expectancy needs to control A1C to prevent kidney, nerve and eye disease later on. For those with shorter life expectancies, goals may be less stringent. This is because diabetes complications develop over the long term.
  • Blood pressure – a goal of 130/80 is common for most patients.
  • Cholesterol – most doctors advise moderate- to high-dose statin therapy for diabetes patients aged 40+ years. The aim is to keep LDL (low-density lipoprotein) levels below 100 milligrams per deciliter. LDL is often referred to as “bad cholesterol”.

Controlling cholesterol levels and blood pressure are extremely important to minimize the risk of developing cardiovascular diseases and/or events. Each goal, however, does not protect against all possible diabetes complications – scientists from Yale University reported in Archives of Internal Medicine that aggressive glucose control may not reduce kidney failure risk in patients with type 2 diabetes.

Below are some data regarding diabetes in the USA that were included in the report:

  • Approximately 26 million people have diabetes in the USA
  • Over 79 million Americans have prediabetes. People with prediabetes have a high risk of developing type 2 diabetes and heart disease.
  • The prevalence of diagnosed diabetes in the USA more than doubled between 1988 and 2012, from nearly 4% to 9% of the national population.

Investigators from Brigham and Women’s Hospital carried out a study which concluded that diabetes patients who had frequent meetings with their doctors were more likely to meet their treatment goals for cholesterol, blood pressure and blood glucose. Their findings were published in Archives of Internal Medicine (September 2011 issue).

The authors explained that even though physicians check their patients’ hemoglobin A1C levels every three months, guidelines for diabetes care offer no suggestions on how often doctors should see their patients. Their findings may offer a solution, the researchers added, recommending that perhaps doctors should meet those with very poor diabetes control every two weeks.

Written by Christian Nordqvist