Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

IMPORTANCE: Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE: To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults betwe...

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Published in:JAMA : the journal of the American Medical Association 2021-08, Vol.326 (8), p.704-716
Main Authors: Wang, Li, Li, Xiaoguang, Wang, Zhaoxin, Bancks, Michael P, Carnethon, Mercedes R, Greenland, Philip, Feng, Ying-Qing, Wang, Hui, Zhong, Victor W
Format: Article
Language:English
Subjects:
Adults
Age
Blood pressure
Cholesterol
Density
Diabetes
Diabetes mellitus
Health risks
Hemoglobin
Hispanic people
Lipoproteins
Men
Nutrition
Older people
Online First
Original Investigation
Polls & surveys
Public health
Risk analysis
Risk factors
Risk management
Trends
Young adults
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container_title JAMA : the journal of the American Medical Association
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creator Wang, Li
Li, Xiaoguang
Wang, Zhaoxin
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Feng, Ying-Qing
Wang, Hui
Zhong, Victor W
description IMPORTANCE: Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE: To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES: Survey cycle. MAIN OUTCOMES AND MEASURES: Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS: Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend
doi_str_mv 10.1001/jama.2021.9883
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OBJECTIVE: To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES: Survey cycle. MAIN OUTCOMES AND MEASURES: Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS: Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend &lt; .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend &lt; .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). CONCLUSIONS AND RELEVANCE: Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2021.9883</identifier><identifier>PMID: 34170288</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adults ; Age ; Blood pressure ; Cholesterol ; Density ; Diabetes ; Diabetes mellitus ; Health risks ; Hemoglobin ; Hispanic people ; Lipoproteins ; Men ; Nutrition ; Older people ; Online First ; Original Investigation ; Polls &amp; surveys ; Public health ; Risk analysis ; Risk factors ; Risk management ; Trends ; Young adults</subject><ispartof>JAMA : the journal of the American Medical Association, 2021-08, Vol.326 (8), p.704-716</ispartof><rights>Copyright American Medical Association Aug 24-Aug 31, 2021</rights><rights>Copyright 2021 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a437t-f597c4db2936de90dfb2e2a660c0d2ddd876e9e7df5e035eae1a391331893f463</citedby><cites>FETCH-LOGICAL-a437t-f597c4db2936de90dfb2e2a660c0d2ddd876e9e7df5e035eae1a391331893f463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34170288$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Li</creatorcontrib><creatorcontrib>Li, Xiaoguang</creatorcontrib><creatorcontrib>Wang, Zhaoxin</creatorcontrib><creatorcontrib>Bancks, Michael P</creatorcontrib><creatorcontrib>Carnethon, Mercedes R</creatorcontrib><creatorcontrib>Greenland, Philip</creatorcontrib><creatorcontrib>Feng, Ying-Qing</creatorcontrib><creatorcontrib>Wang, Hui</creatorcontrib><creatorcontrib>Zhong, Victor W</creatorcontrib><title>Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>IMPORTANCE: Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE: To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES: Survey cycle. MAIN OUTCOMES AND MEASURES: Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS: Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend &lt; .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend &lt; .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). CONCLUSIONS AND RELEVANCE: Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.</description><subject>Adults</subject><subject>Age</subject><subject>Blood pressure</subject><subject>Cholesterol</subject><subject>Density</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Health risks</subject><subject>Hemoglobin</subject><subject>Hispanic people</subject><subject>Lipoproteins</subject><subject>Men</subject><subject>Nutrition</subject><subject>Older people</subject><subject>Online First</subject><subject>Original Investigation</subject><subject>Polls &amp; surveys</subject><subject>Public health</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Risk management</subject><subject>Trends</subject><subject>Young adults</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNpdkc1r3DAQxUVpaLZprj30UAS59FBv9GHZ0qWwbJoPCCQ0u2ehtcaJN7a0leyF_veVs8mSRJcBze89ZuYh9JWSKSWEnq5NZ6aMMDpVUvIPaEIFlxkXSn5EE0KUzMpc5ofoc4xrkh7l5Sd0yHNaEiblBFWLAM5G3Dh8G2BrWnAVYF_js8asoIeIjbN47l0ffDv-_2niIz43Ve_Dk2rPzTrv7vHyDs_s0PbxJ6ZKqYwRKr-gg9q0EY6f6xFanv9ezC-z65uLq_nsOjM5L_usFqqscrtiihcWFLH1igEzRUEqYpm1VpYFKChtLYBwAQao4YpyTqXidV7wI_Rr57sZVh3YCtLQptWb0HQm_NPeNPptxzUP-t5vtWScqyeDH88Gwf8dIPa6a2IFbWsc-CFqJnIhVJ7ohJ68Q9d-CC6tl6h0ciJEQRM13VFV8DEGqPfDUKLH_PSYnx7z02N-SfD99Qp7_CWwBHzbAaPupctKSQtG-H_oYZ1D</recordid><startdate>20210824</startdate><enddate>20210824</enddate><creator>Wang, Li</creator><creator>Li, Xiaoguang</creator><creator>Wang, Zhaoxin</creator><creator>Bancks, Michael P</creator><creator>Carnethon, Mercedes R</creator><creator>Greenland, Philip</creator><creator>Feng, Ying-Qing</creator><creator>Wang, Hui</creator><creator>Zhong, Victor W</creator><general>American Medical Association</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210824</creationdate><title>Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018</title><author>Wang, Li ; 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OBJECTIVE: To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES: Survey cycle. MAIN OUTCOMES AND MEASURES: Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS: Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend &lt; .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend &lt; .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). CONCLUSIONS AND RELEVANCE: Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34170288</pmid><doi>10.1001/jama.2021.9883</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record>
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source American Medical Association Current Titles
subjects Adults
Age
Blood pressure
Cholesterol
Density
Diabetes
Diabetes mellitus
Health risks
Hemoglobin
Hispanic people
Lipoproteins
Men
Nutrition
Older people
Online First
Original Investigation
Polls & surveys
Public health
Risk analysis
Risk factors
Risk management
Trends
Young adults
title Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018
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