Blood Sugar Management is Worsening Amongst People With Diabetes

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Type 2 diabetes is the most common form of the disease and is highly dependent on diet and lifestyle factors. It affects more than 13% of the adult population in the United States and increases the risk of other serious illnesses, particularly cardiovascular disease, according to the study. The traditional approaches to treating diabetes have been to lower chronically high blood sugar, keep blood pressure below hypertensive levels, and control cholesterol levels.

According to the study, the proportion of adults with blood sugar control improved between 1999 and 2007, but then fell from 57.4% to 50.5% between 2007 and 2018. The study authors also observed a decrease in the proportion of people who achieved blood pressure control, while the proportion who achieved cholesterol control leveled off.

“This affects the results,” senior writer Elizabeth Selvin, PhD, MPH, professor in the Bloomberg School’s Department of Epidemiology, said in the press release. “Blood sugar control has really gone down 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.”

For their study, investigators had access to data that included interviews and clinical examinations of about 5,000 people across the country. The sample consisted of 6,653 participants in the surveys from 1999 to 2018, who were at least 20 years old, were not pregnant and stated that they had been diagnosed with diabetes outside of pregnancy.

Between 1999 and 2010, the percentage of respondents who achieved glycemic control, defined as HbA1c levels below 7.0%, increased from 44% to 57.4%. This percentage then fell sharply between 2015 and 2018. Similarly, the percentage who achieved blood pressure control rose steadily from 64% between 1999 and 2002 to 74.2% between 2011 and 2014, and then fell to 70.4% between 2015 and 2018.

Eventually, the proportion of people with diabetes who controlled non-high-density lipoprotein (non-HDL) cholesterol increased from 25.3% between 1999 and 2002 to 52.3% between 2007 and 2010, but then only reached between 2015 and 2018 55.7% The proportion of people who had all 3 risk factors under control increased from 9% between 1999 and 2002 to 24.9% between 2007 and 2010 and then decreased to 22.2% between 2015 and 2018.

“These trends are a wake-up call as they mean that millions of Americans with diabetes are at greater risk for serious complications,” lead study author Michael Fang, PhD, a postdoctoral fellow at Bloomberg School, said in the press release. “Our study suggests that a deterioration in diabetes control could already have negative effects at the national level.”

In addition, the results suggest that something has changed since 2010 to slow progress in controlling these risk factors for diabetes. In the press release, Selvin said two large clinical studies published in 2008 could be a reason for this slowed progress. The studies found that deeply lowering HbA1c to very low levels did not produce the expected cardiovascular benefits, and some study participants saw an increased risk of hypoglycaemia.

“As a result of these studies, we may see that doctors of people with diabetes may have reduced blood sugar control levels somewhat, with potentially harmful results,” Selvin said in the press release.

She noted that since these results were published in 2008, there have been many new and improved diabetes drugs that make it possible to lower HbA1c without causing hypoglycemia.

REFERENCE

Large study of diabetes trends shows Americans are getting worse blood sugar control [news release]. Johns Hopkins Bloomberg School of Public Health. June 9, 2021. Accessed June 22, 2021. https://www.jhsph.edu/news/news-releases/2021/major-study-of-diabetes-trends-shows-americans-blood-sugar-control- is-always-worse.html