Glycemic Control Among Patients With Diabetes Worsened Over Past Decade
Authors of a research letter published in JAMA said that the decrease in glycemic control may be due to consequences of the COVID-19 pandemic, such as sedentary behavior and increased mental health stressors.
Although the prevalence of diabetes among adults did not change significantly between 2013 and 2023 in the United States, new data shows that glycemic control among patients with the condition worsened. The research letter, published in JAMA, highlights the importance of public health and policy efforts aimed at improving diabetes control.1
Glycemic Control Among Patients With Diabetes Worsened Over Past Decade / Goffkein - stock.adobe.com
Diabetes is a leading public health threat in the US, with an estimated 38.4 million people being impacted by the condition.2 An estimated 97.6 million adults have prediabetes, which can turn into type 2 diabetes if left untreated. There were 103249 deaths due to diabetes in 2021, making it the eighth leading cause of death in the country.
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“Although diagnosis and management of chronic conditions were affected by disruptions in care access and health behaviors during the COVID-19 pandemic, little is known about how the burden of diabetes changed in recent years,” the authors wrote.
Investigators analyzed data to evaluate trends in the prevalence and control of diabetes among American adults overall and by age and sex. Data for the review was gathered from the National Health and Nutrition Examination Survey (NHANES) between 2013 and August 2023. The survey is nationally representative of noninstitutionalized citizens and is conducted through interviews done at homes and mobile examination centers.
Participants were included in the review if they were not pregnant, were older than 20 years of age, and had available HbA1c measurements. Diabetes was defined as an HbA1c level 6.5% or greater, fasting plasma glucose level 126 mg/dL or greater, or a diagnosis of diabetes. Glycemic control was defined as an HbA1c level less than 7%. Data on age and sex was collected through questionnaires.
The study cohort included 24263 participants, of which 51.4% were female with a mean age of 48.5 years. From 2013-2014 to 2021-2023, NHANES response rates decreased from 68.5% to 25.7%. Of the included participants, 4623 had diabetes. The review found that the prevalence of diabetes did not change significantly during the period. In 2013-2014 the prevalence was 12.8% and increased to 14.1% in 2021-2023.
Among the participants who did have diabetes, HbA1c levels remained stable between 2013-2014 and 2017-2020. However, they increased significantly in 2021-2023, spiking from 7.31% in 2017-2020 to 7.60% in 2021-2023. Glycemic control rates were also stable between 2013-2014 and 2017-2020, but decreased from 54.3% in 2017-2020 to 43.5% in 2012-2023.
The increases in mean HbA1c levels were concentrated mostly among young adults between the ages of 20 and 44 years. This age group also experienced a significant decline in glycemic control rates. This was not seen among the participants of other age or sex subgroups.
The authors said that certain consequences of the COVID-19 pandemic, such as more sedentary behavior, lack of social support, increased mental health stressors, and reduced health care and medication access, may be potential explanations for the decrease in glycemic control among young adults with diabetes.
“Given the recent stagnation in mortality improvement among young adults with diabetes and the increased risk of adverse cardiovascular outcomes associated with poor glycemic control, public health and policy efforts are needed to improve diabetes control, especially in younger populations,” the authors concluded.
READ MORE: Diabetes Resource Center
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