From the Journals

Diabetes targets remain elusive for patients



Some things never change: In 2005, most adults with diabetes missed their treatment targets. In 2016, most adults with diabetes missed their treatment targets. And during that time, from 2005 to 2016, around 96% of men and 94% of women were linked to care.

Adults diagnosed with diabetes who achieved targets

“Fewer than one in four American adults with diagnosed diabetes achieve a controlled level of blood sugar, blood pressure, and cholesterol, and do not smoke tobacco. Our results suggest that, despite major advances in diabetes drug discovery and movement to develop innovative care delivery models over the past two decades, achievement of diabetes care targets has not improved in the United States since 2005,” Pooyan Kazemian, PhD, of Massachusetts General Hospital, Boston, said in a written statement.

During 2013-2016, only 23% of adults with diabetes met a combined composite target of glycemic (HbA1c below a liberal personalized level), blood pressure (less than 140/90 mm Hg), and cholesterol (LDL cholesterol level less than 100 mg/dL) control, as well as not smoking tobacco, Dr. Kazemian and associates reported in JAMA Internal Medicine. The corresponding figures were 25% (2009-2012) and 23% (2005-2008) for the two earlier time periods covered in the study,

The investigators used data for 1,742 nonpregnant adults from the National Health and Nutrition Examination Survey to evaluate the diabetes care cascade, which they defined as “diagnosis, linkage to care, achievement of individual treatment targets, and a composite of all individual targets.”

In 2013-2016, 94% of those diagnosed were linked to care, 64% met their HbA1c target, 70% achieved blood pressure control, 57% met the cholesterol target, and 85% were nonsmokers. When targets were combined, 41% achieved blood pressure and cholesterol control, and 25% met the glycemic, blood pressure, and cholesterol targets, they said.

“We found that none of the U.S. diabetes care variables improved from 2005 to 2016,” Dr. Kazemian and associates noted. Women were less likely than men to meet their treatment goals (see graph) over the course of the study, as were adults aged 18-44 years and black and Hispanic individuals.

“Recent advances in [treatments for diabetes] have not effectively reached the populations at risk and may indicate an immediate need for better approaches to the delivery of diabetes care, including a continued focus on reaching underserved populations with persistent disparities in care,” they wrote.

The study was supported by the Boston Area Diabetes Endocrinology Research Center and Massachusetts General Hospital. One investigator reported that her husband has equity in Apolo1bio. No other disclosures were reported.

SOURCE: Kazemian P et al. JAMA Intern Med. 2019 Aug 12. doi: 10.1001/jamainternmed.2019.2396.

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