Diabetes treatment targets stagnant in US since 2005, analysis shows over 1 in 4 adults with the disease remain undiagnosed
Significant advances over the past two decades have not effectively improved diabetes outcomes in particular for young, female and non-white adults with diabetes.
Millions in the US are affected by diabetes but advances over the past two decades have not translated into meaningful improvement in treatment outcomes. More than 1 in 4 adults with diabetes were not diagnosed and nearly 1 in 3 were not receiving appropriate care for their diabetes, shows analysis of data since 2005.
Diabetes is a major US public health burden, affecting 30.2 million adults, with an expected prevalence of 54 million by 2030. Diabetes treatment is generally focused on controlling blood sugar, blood pressure, and cholesterol level, as well as a no-smoking target. A new study by the Massachusetts General Hospital (MGH) now finds that the achievement of these treatment targets has not improved for US adults with diabetes since 2005.
“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, the achievement of diabetes care targets has not improved in the US since 2005", says lead researcher Pooyan Kazemian, MGH Medical Practice Evaluation Center, and instructor in Medicine at Harvard Medical School (HMS).
The team analyzed the National Health and Nutrition Examination Survey (NHANES) cross-sectional data from 2005 to 2016. The researchers conducted statistical analyses on the data obtained from the Centers for Disease Control and Prevention (CDC) to evaluate the cascade of diabetes care in the US, which is defined as diabetes diagnosis, linkage to care and achievement of treatment targets.
“Our investigations noted that in the most recent period (2013-16), less than 1 in 4 US adults with diagnosed diabetes met the composite glycemic, blood pressure, cholesterol, and non-smoking target. In addition, we found that none of the US diabetes care variables improved from 2005 to 2016,” says the study published in JAMA Internal Medicine.
According to the researchers, treatment advances in diabetes can meaningfully improve outcomes only if they effectively reach the populations at risk. However, the results, the team says, suggest that recent advances in diabetes treatment have not effectively reached the populations at risk and calls for an immediate need for better approaches to diabetes care delivery, including a continued focus on reaching underserved populations with persistent disparities in care.
Lack of health insurance, high drug costs responsible for unmet targets
The research team also investigated potential age, gender, and racial disparities in diabetes care. They found that specific populations had persistent gaps in meeting diabetes care targets over the study period. The findings reveal that younger age (18-44), female and non-white adults with diabetes had lower odds of achieving the composite blood sugar, blood pressure, cholesterol, and non-smoking target.
“Given that diabetes morbidity and mortality are mainly due to complications that accumulate over time, interventions to promote early control of risk factors for young adults with diabetes should be further expanded. Also, access to care and sex disparities in the treatment of cardiac risk factors may have contributed to the sex disparities,” the findings state.
Insurance coverage was the strongest indicator of diagnosis, linkage, and achievement of diabetes treatment targets. According to the research team, barriers accessing healthcare, including lack of health insurance and high drug costs, remain significant factors that have not been adequately addressed.
“More-frequent diabetes screening, expanded access to care and health insurance, and interventions to improve patients’ adherence to medication and to reduce clinical inertia must remain strategies to improve diabetes outcomes in the US,” recommend the researchers.
They add, “lack of access to care may be an important modifiable factor. Cholesterol level control and achievement of the composite goals were better among adults who were linked to diabetes care compared with those who were not linked or diagnosed.”