The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of ...type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication, and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.
To determine the prevalence of people with diabetes who meet hemoglobin A1c (A1C), blood pressure (BP), and LDL cholesterol (ABC) recommendations and their current statin use, factors associated with ...goal achievement, and changes in the proportion achieving goals between 1988 and 2010.
Data were cross-sectional from the National Health and Nutrition Examination Surveys (NHANES) from 1988-1994, 1999-2002, 2003-2006, and 2007-2010. Participants were 4,926 adults aged ≥ 20 years who self-reported a previous diagnosis of diabetes and completed the household interview and physical examination (n = 1,558 for valid LDL levels). Main outcome measures were A1C, BP, and LDL cholesterol, in accordance with the American Diabetes Association recommendations, and current use of statins.
In 2007-2010, 52.5% of people with diabetes achieved A1C <7.0% (<53 mmol/mol), 51.1% achieved BP <130/80 mmHg, 56.2% achieved LDL <100 mg/dL, and 18.8% achieved all three ABCs. These levels of control were significant improvements from 1988 to 1994 (all P < 0.05). Statin use significantly increased between 1988-1994 (4.2%) and 2007-2010 (51.4%, P < 0.01). Compared with non-Hispanic whites, Mexican Americans were less likely to meet A1C and LDL goals (P < 0.03), and non-Hispanic blacks were less likely to meet BP and LDL goals (P < 0.02). Compared with non-Hispanic blacks, Mexican Americans were less likely to meet A1C goals (P < 0.01). Younger individuals were less likely to meet A1C and LDL goals.
Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups. Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes-related morbidity and mortality.
OBJECTIVE We examined prevalences of previously diagnosed diabetes and undiagnosed diabetes and high risk for diabetes using recently suggested A1C criteria in the U.S. during 2003-2006. We compared ...these prevalences to those in earlier surveys and those using glucose criteria. RESEARCH DESIGN AND METHODS In 2003-2006, the National Health and Nutrition Examination Survey included a probability sample of 14,611 individuals aged > or =12 years. Participants were classified on glycemic status by interview for diagnosed diabetes and by A1C, fasting, and 2-h glucose challenge values measured in subsamples. RESULTS Using A1C criteria, the crude prevalence of total diabetes in adults aged > or =20 years was 9.6% (20.4 million), of which 19.0% was undiagnosed (7.8% diagnosed, 1.8% undiagnosed using A1C > or =6.5%). Another 3.5% of adults (7.4 million) were at high risk for diabetes (A1C 6.0 to <6.5%). Prevalences were disproportionately high in the elderly. Age-/sex-standardized prevalence was more than two times higher in non-Hispanic blacks and Mexican Americans versus non-Hispanic whites for diagnosed, undiagnosed, and total diabetes (P < 0.003); standardized prevalence at high risk for diabetes was more than two times higher in non-Hispanic blacks versus non-Hispanic whites and Mexican Americans (P < 0.00001). Since 1988-1994, diagnosed diabetes generally increased, while the percent of diabetes that was undiagnosed and the percent at high risk of diabetes generally decreased. Using A1C criteria, prevalences of undiagnosed diabetes and high risk of diabetes were one-third that and one-tenth that, respectively, using glucose criteria. CONCLUSIONS Although A1C detects much lower prevalences than glucose criteria, hyperglycemic conditions remain high in the U.S., and elderly and minority groups are disproportionately affected.
In his January 2015 State of the Union address, President Barack Obama announced a new Precision Medicine Initiative (PMI) to personalize approaches toward improving health and treating disease ...(www.whitehouse.gov/precision-medicine). He stated that the goal of such an initiative was "to bring us closer to curing diseases like cancer and diabetes, and to give all of us access to the personalized information we need to keep ourselves and our families healthier." Since that time, the National Institutes of Health (NIH) has taken a leadership role in implementing the President's vision related to biomedical research (www.nih.gov/precisionmedicine). Here, we discuss the NIH component of the PMI, related ongoing diabetes research, and near-term research that could position the diabetes field to take full advantage of the opportunities that stem from the PMI.
The rising tide of diabetes has an unacceptable human and societal toll. Rates of all major forms of diabetes are increasing at enormous individual and societal cost: 8.3 percent of the US population ...is afflicted today, and financial costs reached $174 billion for 2007. A major cause of blindness, renal failure, amputation, and cardiovascular disease, diabetes also increases the risk of cancer and dementia and more than doubles individual health care costs. Control of glucose, blood pressure, and lipids improves outcomes. Yet diabetes management is nonetheless suboptimal, particularly in disproportionately affected poor and minority populations. Safer, less burdensome, and more personalized approaches to therapy are needed. People at high risk for type 2 diabetes must be identified if society is to realize the benefits of therapies proven to delay or prevent the disease. We have many of the tools we need to address this challenge, and we must apply them now.
Background Federal law requires certain private insurers to cover and waive patient cost sharing for preventive medical services that receive a grade of B or better from the U.S. Preventive Services ...Task Force (USPSTF). The USPSTF recommends that asymptomatic adults who have a blood pressure (BP) higher than 135/80 mmHg be screened for type 2 diabetes. Purpose The goals of this study were to determine the sensitivity and specificity of the USPSTF screening criteria and to determine the prevalence of cardiovascular risk factors and comorbidity among undiagnosed individuals by USPSTF criteria. Methods Data come from 7189 adults who participated in the 2003–2010 National Health and Nutrition Examination Survey; statistical analysis was conducted in 2011–2012. Participants with fasting plasma glucose ≥126 mg/dL or hemoglobin A1c (HbA1c) ≥6.5% who did not self-report a diagnosis of diabetes were categorized as having undiagnosed diabetes. Results Among people without diagnosed diabetes, 4.0% had undiagnosed diabetes. The proportion of adults with undiagnosed diabetes who were identified (sensitivity) using BP >135/80 mmHg as the screening standard was 44.4%; among individuals without undiagnosed diabetes, 74.8% had BP ≤135/80 mmHg (specificity). For those with undiagnosed diabetes, the prevalence of HbA1c 7.0%–<8.0% was 10.6% for those with BP ≤135/80 mmHg and 14.3% for those with BP >135/80 mmHg; and 12.8% and 9.4% for HbA1c ≥8.0%, respectively. Elevated low-density lipoprotein (100–160 mg/dL) was similar by BP cut-point (52%–53%). For those with BP ≤135/80 mmHg, 16.7% had a history of cardiovascular disease and 22.9% had chronic kidney disease. Conclusions The USPSTF screening recommendations result in missing more than half of those who have undiagnosed diabetes, and a substantial proportion of these people have increased low-density lipoprotein and other cardiovascular risk factors.
Abstract Aims To determine the extent to which older vs. younger adults with diabetes intensively control glycemia. Methods Participants were age ≥ 40 years who self-reported a physician diagnosis of ...diabetes in the 2009–2014 National Health and Nutrition Examination Surveys (N = 1554). Intensive glycemic control was defined as A1c < 7.0% and taking insulin, sulfonylureas, or ≥ 2 glycemic medications. Logistic regression was used to determine the adjusted odds of intensive control in older (≥ 65 years) vs. younger adults (age 40–64 years). Results The prevalence of intensive control was greater for older (33.4%) vs. younger (21.3%) adults (p < 0.001). In logistic regression, intensive control was significantly higher in older vs. younger adults after fully adjusting for sociodemographics, diabetes duration, comorbidities, disability, use of multiple medications, and depression (OR = 1.72, 1.09–2.69). The multivariable adjusted prevalence of intensive control was 40% higher in adults ≥ 75 years (35.6%) compared to adults 40–49 years (21.7%). Conclusions Older adults are being treated more aggressively than younger adults to achieve A1c < 7.0% despite the presence of comorbidities, duration of diabetes, disability, and depression. Glycemic guidelines for individualized therapy are not being widely followed.
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