June 9, 2021 – Fewer adults with diabetes in the United States now have well-controlled blood sugar or blood pressure compared to 10 years ago, a trend that should be a “wake-up call,” say news authors study. published today in the New England Journal of Medicine
The researchers analyzed data from five major surveys of the health and nutrition of Americans over the past 20 years, called National Health and Nutrition Surveys.
They aimed to find out how many people with diabetes met the three ABCs recommended for 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 improved, but since then progress has stalled.
In the most recent survey, conducted from 2015 to 2018, only 22% of people with diabetes had all three measures under control.
“Regarding the results, a wake-up call”
“These trends are a wake-up call,” said lead author of the study, Michael Fang, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
“They mean that 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 amputation of the foot, kidney disease, and heart attack.
The results are “concerning,” agreed study lead author Elizabeth Selvin, PhD, professor in the epidemiology department at the Bloomberg School.
“There has been a real decline in glycemic control over the past decade, and overall, only a small proportion of people with diabetes meet the key goals of glycemic control, blood pressure control and blood pressure control simultaneously. ‘hypercholesterolemia,’ she summed up.
Selvin suggests that two large clinical trials published in 2008 may partly explain these disturbing new trends.
Trials found that treating patients with diabetes medications to achieve very low blood sugar goals did not reduce the risk of outcomes such as heart attacks and strokes.
And some people receiving this intensive treatment were more likely to develop dangerously low blood sugar (hypoglycemia).
“As a result of these trials, what we can see is that doctors of people with diabetes may have backed down a bit on glycemic control, with potentially damaging results,” Selvin speculated.
However, many new, safer diabetes drugs have become available since these trials, she noted, although cost remains an issue.
Generic diabetes drugs on the horizon
Researchers analyzed data from 6,653 adults with diabetes who participated 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, then fell to 51% in the final survey.
It is important to note that the proportion of people with good control of the three diabetes management measures increased from 9% in the first survey to 25% in the third survey, but then slipped to 22% in the last. investigation.
The use of other newer second-line drugs for blood sugar control (usually given after trying metformin, the first-line treatment for type 2 diabetes) has increased but remains low, the researchers note.
Many of these new diabetes drugs, they say, will become generic and more affordable over the next few years, which could help stop this trend of worsening diabetes control.
In the meantime, they say, doctors should prescribe more of the drugs recommended by the guidelines to treat high blood sugar levels, high blood pressure, and bad cholesterol.
Only 56% to 60% of the diabetic patients surveyed were receiving metformin, ACE inhibitors or angiotensin receptor blockers (ARBs) for high blood pressure, or statins for high cholesterol.