Diabetes Goals: The Good and Bad News
New research published in Diabetes Care indicates that while important strides were taken between 1988–1994 and 2007–2010 among diabetics in achieving target HbA1c, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) goals, disparities in certain subgroups suggest an “urgent need” for additional treatments and care.
The findings came from a nationally representative sample of 4,926 participants in the National Health and Nutrition Examination Surveys from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Participants, 20 years or older, self-reported a previous diagnosis of diabetes and completed household surveys and physical examinations. American Diabetes Association (ADA)-recommended levels of HbA1c, BP, and LDL-C, and current use of statins were the outcomes measured.
The study’s good news is that in the most recent time period, 18.8% of participants achieved all three goals—HbA1c <7.0%, BP <130/80 mmHg, and LDL-C <100 mg/dL—compared with just 1.7% in 1988–1994. The researchers attributed these gains to the advent of new and improved therapeutic agents and more evidence about the benefits of risk factor control.
At the same time, however, the authors found some troubling trends. Most notably, about 30% of younger adults, Hispanics, and those with diabetes for at least 20 years had HbA1c levels ≥8.0%. In addition, approximately 40% of those taking insulin had HbA1c values ≥8.0%.
The authors hypothesized that poor diabetic control in these groups might stem from several factors. Some people might not be able to achieve ADA-recommended targets due to the severity of their disease or complications. In addition, they might lack self-management skills, resources to adhere to demanding self-care regimens, or individualized care. Furthermore, current thinking recognizes that not every person should be expected to reach the targets.
The authors concluded that managing diabetes "remains very complex and challenging, requiring access to a skilled team of clinicians and diabetes educators and imposing major burdens on families and health systems."