June 9, 2021 — Fewer adults with diabetes in the United States now have well-controlled blood sugar, or blood pressure, than they did 10 years ago, a trend that should be a “wake call,” say the authors of a new study. published today in New England Journal of Medicine
Researchers analyzed data from five large health and nutrition surveys of Americans over the past 20 years, called the National Health and Nutrition Examination Survey.
They aimed to find out how many people with diabetes met 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.
From 1999 to 2010, diabetes control was improving, 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 under good control.
‘With regard to the findings, a wake-up call’
“These trends are a wake-up call,” said study lead author Michael Fang, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
“They mean that the millions of Americans with diabetes are at higher risk for major complications,” he said in a statement from the university.
Complications of poorly controlled diabetes include leg amputation, kidney disease and heart attack.
The findings are “concerning,” agrees senior study author Elizabeth Selvin, PhD, professor in the Bloomberg School’s Department of Epidemiology.
“There has been a real decline in glycemic control since a decade ago, and overall, only a small proportion of people with diabetes are simultaneously meeting the key goals of glycemic control, blood pressure control, and control of high cholesterol,” she summarized. said in.
Selvin suggests that two large clinical trials published in 2008 may partly explain these disturbing new trends.
The trials found that treating patients with diabetes drugs to reach the target of very low blood sugar did not reduce the risk of outcomes such as heart attack and stroke.
And some people receiving this intensive treatment were more likely to develop dangerously low blood sugar levels (hypoglycemia).
Selvin speculates, “As a result of these trials, what we are seeing is that doctors of people with diabetes may have had little support on glycemic control, with potentially harmful consequences.”
However, many newer, safer diabetes drugs have become available since those trials, he said, although cost is still an issue.
Generic diabetes drugs on the horizon
Researchers analyzed data from 6,653 adults with diabetes who took part in national health surveys conducted between 1999-2002, 2003-2006, 2007-2010, 2011-2014 and 2015-2018.
The percentage of people with good blood sugar control increased from 44% in the first survey to 57% in the 2007–2010 survey and then fell to 51% by the last survey.
Importantly, the proportion of people with good control of all three measures of diabetes care increased from 9% in the first survey to 25% in survey three, but then fell to 22% at the last survey.
The use of other new second-line drugs for blood sugar control (usually given after trying metformin, the first-line treatment for type 2 diabetes) has increased, but is still low, note the researchers.
Many of these new diabetes drugs will become generic and more affordable over the next several years, they hope, which could help halt this trend of worsening diabetes control.
In the meantime, he says, doctors should be prescribing more drugs than guidelines recommend, which are previously used to treat high levels of blood sugar, blood pressure and bad cholesterol.
Only 56% to 60% of patients with diabetes surveyed were receiving metformin, ACE inhibitors, or angiotensin receptor blockers (ARBs) for high blood pressure, or statins for high cholesterol.