June 9, 2021 – Compared to 10 years ago, fewer adults with diabetes in the US now have well-controlled blood sugar or blood pressure, a trend that should be a “wake-up call,” the authors of a new study say in the New England Journal of today Medicine published
The researchers analyzed data from five major health and nutrition surveys of Americans over the past 20 years, called the National Health and Nutrition Examination Surveys.
They wanted to find out how many people with diabetes meet the three recommended ABCs of good diabetes control:
- A1c, a measure of blood sugar control: less than 7%
- Blood pressure: less than 140/90.
- Cholesterol (non-HDL cholesterol or “bad” cholesterol): less than 130.
Diabetes control improved from 1999 to 2010, but progress has stalled since then.
In the most recent survey, conducted from 2015 to 2018, only 22% of people with diabetes had all three measures well under control.
“In terms of findings, a wake-up call”
“These trends are a wake-up call,” said the study’s lead author, Michael Fang, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
“They mean millions of Americans with diabetes are at greater risk of serious complications,” he said in a university statement.
Complications from poorly controlled diabetes are foot amputation, kidney disease and heart attacks.
The results are “worrying,” agreed lead study author Elizabeth Selvin, PhD, professor in the Bloomberg School’s epidemiology department.
“Blood sugar control has really been in decline for a decade, and overall, only a small fraction of people with diabetes achieve key goals of blood sugar control, blood pressure control, and high cholesterol control at the same time,” she summarizes.
Selvin suggests that two large clinical studies published in 2008 might partially explain these disturbing new trends.
The studies found that treating patients with diabetes medications to achieve very low blood sugar goals did not reduce the risk of complications such as heart attacks and strokes.
And some people who received this intensive treatment were more likely to develop dangerously low blood sugar levels (hypoglycemia).
“As a result of these studies, we may see that doctors of people with diabetes may have decreased blood sugar control levels somewhat, with potentially harmful results,” speculated Selvin.
However, since those studies, many new, safer diabetes drugs have become available, she noted, although cost is still an issue.
Generic diabetes drugs on the horizon
The researchers analyzed data from 6,653 adults with diabetes who participated in national health surveys in 1999-2002, 2003-2006, 2007-2010, 2011-2014, and 2015-2018.
The proportion of people with good glycemic control increased from 44% in the first survey to 57% in the 2007-2010 survey and then decreased to 51% by the last survey.
It is important that the proportion of people with good control over all three diabetes care measures increased from 9% in the first survey to 25% in the third survey, but then slipped to 22% in the last survey.
My son’s annual diabetes rating was excellent. The average blood sugar was in the non-diabetic range, which means he has excellent blood sugar control 👏🏻 proud of my baby
– Sarah 👾 (@cainie) June 9, 2021
The use of other newer, second-line blood sugar control drugs (generally given after trying metformin, the first-line treatment for type 2 diabetes) has increased but is still low, the researchers note.
Many of these newer diabetes drugs will become more generic and more affordable in the next few years, which could help halt this trend of worsening diabetes control.
In the meantime, doctors should prescribe more drugs recommended in the guidelines to treat high blood sugar levels, blood pressure, and bad cholesterol.
Only 56 to 60% of the surveyed patients with diabetes received metformin, ACE inhibitors or angiotensin receptor blockers (ARBs) for high blood pressure or statins for high cholesterol levels.
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New England Journal of Medicine: “Trends in the Treatment and Control of Diabetes”
in US adults, 1999-2018. “
Michael Fang, PhD, postdoctoral fellow, Johns Hopkins Bloomberg School of Public Health, Baltimore.
Elizabeth Selvin, PhD, Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.
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