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Big Improvement In Diabetes Control Over Past Decades


About 26 million Americans have diabetes, and another 79 million have prediabetes, a condition that places them at increased risk for developing type 2 diabetes and heart disease. Between 1988 and 2012, the prevalence of diagnosed diabetes has more than doubled, from nearly 4% of the U.S. population to nearly 9%, according to data from the Centers for Disease Control and Prevention.


According to a report published online in Diabetes Care (15 February 2013), more people are meeting recommended goals in the three key markers of diabetes control. The study showed that from 1988 to 2010, the number of people with diabetes able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2% to about 19%. Each measure also showed substantial improvement, with over half of people meeting each individual goal in 2010. However, despite improvement, the results show continued need for better diabetes control. In particular, young people and some minority groups were below average in meeting the goals.


The measures are A1C — which assesses blood sugar (glucose) over the previous three months — blood pressure and cholesterol. They are often called the ABCs of diabetes. When these measures fall outside healthy ranges, people are more likely to be burdened by complications of diabetes, including heart disease, stroke, kidney disease, blindness, and amputation.


To gauge diabetes management, researchers analyzed data from the National Health and Nutrition Examination Surveys from 1988-1994 and 1999-2010.


According to 2007-2010 data on Americans with diabetes:

— 53% met A1C goals, compared to 43% in 1988-1994 data

— 51% met blood pressure goals, compared to 33% in 1988-1994 data

— 56% met cholesterol goals, compared to 10% in 1988-1994 data


Improved cholesterol control was likely due to the increase in the use of statins, a type of cholesterol-lowering drug, from about 4% of people with diabetes during 1988-1994 to 51% during 2007-2010. Glucose control was worse in Mexican-Americans and in younger adults. Only 44% of Mexican-Americans met A1C goals, versus 53% of whites and blacks in 2007-2010 data. People between 20-49 years old were less likely to meet A1C goals than older people.


Goals for A1C, blood pressure, and cholesterol must be individualized for people with diabetes, as effects of diabetes can differ depending on a person’s age, type of diabetes, diabetes medications, complications from diabetes, and other factors.


For A1C, a goal for many people is below 7%. It is particularly important for people with long life expectancies to control A1C to protect against eye, nerve, and kidney disease in the future. Goals can be less stringent for people with limited life expectancy, since complications develop over time. For blood pressure, the goal for most people is 130/80. Moderate- or high-dose statin therapy is recommended for people over 40 with diabetes, with a goal of keeping the low-density lipoprotein (LDL) — sometimes called bad cholesterol — less than 100 milligrams per deciliter. Control of blood pressure and cholesterol are particularly important for lowering cardiovascular risk.


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