Only 23% of adults with diabetes achieve targets

New analysis shows that the average care-goal for achieving targets among adults with diabetes has not improved over the past 12 to 15 years. The research, Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016, features in August 12 edition of JAMA Internal Medicine.  The study concludes that less than a quarter of people with diabetes (23%) achieved all four diabetes targets (HbA1c, blood pressure, cholesterol and smoking cessation).

The investigation used data from the 2005-2008, 2009-2012, and 2013-2016 cycles of the National Health and Nutrition Examinations Survey (NHANES) to assess care and treatment from diagnosis to combined achievement of cardiometabolic targets. Findings of the study saw 1/4 undiagnosed American adults with fasting glucose-defined and HbA1c  defined diabetes. Among those with diagnosed diabetes, 64% achieved individualized HbA1c targets (7.0%-8.5%, depending on age and complications), 70% met blood pressure targets (<140/90 mm Hg), 57% met low-density lipoprotein targets (cholesterol <100 mg/dL), and 85% smoking cessation targets. Only 23% met all composite targets.  Of note, are the young adults (18-44), women, non-Hispanic blacks, and uninsured respondents who fared worse than their counterparts. Having health insurance was the strongest predictor of linkage to diabetes care.

“Our findings indicate an immediate need for better approaches to diabetes care delivery and policy-level initiatives to address socioeconomic disparities. More frequent diabetes screening, expanded access to care and health insurance, and interventions to improve patients’ adherence to medication and reduce clinical inertia should remain strategies to improve diabetes outcomes,” says Pooyan Kazemian, instructor at Harvard Medical School, who co-authored the investigation.

The study may reflect how expensive diabetes advances, including technology, are not making enough of an impact because they are unaffordable to most people living with diabetes. The high cost of insulin and basic clinical care are also out of reach for too many in the US, insured and uninsured. These factors can certainly be seen as barriers for people achieving all targets.  Low public awareness, and poor individual understanding and education of diabetes and cardiovascular disease may also be issues.

Dr. Kazemian agrees, “Our study demonstrated that insurance coverage has been the strongest indicator of diagnosis, linkage to diabetes care, and achievement of diabetes treatment targets in the past 15 years. Therefore, by making healthcare more affordable, accessible, and efficient, we can take an important step toward improving diabetes outcomes in the United States.”