The authors of a new study published in the New England Journal of Medicine say a trend that’s been called a “wake-up call” is that fewer adults today have diabetes in the United States. Ky can control blood sugar or blood pressure better than 10 years ago.

The researchers analyzed data from five National Health and Nutrition Examination Surveys (NHANES) of Americans conducted over the past 20 years.

Their aim was to find out how many people with diabetes meet the three recommended goals of good diabetes control:

HbA1C: <7%

Blood pressure: <140/90mmHg

Non-HDL-C: <130mg/dL

Between 1999 and 2010, diabetes control improved, but since then progress has stalled.

In the most recent survey, conducted between 2015 and 2018, only 22% of people with diabetes met all three of the above controls.

“Regarding the findings, a wake-up call”

“These trends are a wake-up call,” said study lead author Michael Fang, a doctoral student at Bloomberg Johns Hopkins School of Public Health, in Baltimore, Maryland.

“That means that millions of Americans are living with diabetes at high risk of complications,” he said in a speech at the university.

Complications of poorly controlled diabetes include leg amputation, kidney disease, and heart attack.

Senior study author Elizabeth Selvin, Master of Public Health, PhD, a Professor in the Department of Epidemiology at the Bloomberg School, agreed that the findings were “remarkable”.

“There was a real decline in glycemic control over the last decade, and overall, only a small percentage of people with diabetes are simultaneously meeting the goals,” she sums up. The main goals are blood sugar control, blood pressure control, and high cholesterol control.”

Selvin suggests that two large clinical trials published in 2008 may partly explain these disturbing trends.

The ACCORD and ADVANCE trials showed that treating patients on diabetes medication to achieve a very low A1c goal did not reduce the risk of outcomes such as heart attack and stroke.

In addition, some people who receive this intensive treatment are more likely to experience hypoglycemia.

“The results of these trials could show us that doctors of people with diabetes don’t place a heavy emphasis on glycemic control, in terms of potentially harmful outcomes.”

However, many new, safer diabetes drugs have emerged since that trial, she noted, although price is also an issue.

Antidiabetic drugs are being developed

The researchers analyzed data from 6653 adults with diabetes who participated in the NHANES survey conducted from 1999-2000, 2003-2006, 2007-2010, 2011-2014, and 2015- 2018.

The percentage of people with good blood sugar control increased from 44% in the first survey to 57% in the 2007-2010 survey and dropped to 51% in the last survey.

Similarly, the percentage of people with good blood sugar control increased from 64% in the first survey to 74% in the fourth survey and dropped to 51% in the fifth survey.

The proportion of people with good control of bad cholesterol improved significantly from 25% in the first survey to 52% in the third survey but then leveled off to 56% in the fifth survey.

Importantly, the proportion of people with good control of all three measures of diabetes care increased from 9% in the first survey to 25% in the third survey but then fell to 22% in the third survey. final survey.

The use of newer alternative medications for blood sugar control (usually used after trying metformin, the preferred treatment for type 2 diabetes) has increased, the researchers noted. short.

Over the next few years, many of these new diabetes drugs will be available in generic regimens and will become more affordable, which they expect could help stem the trend of diabetes control. It’s getting worse .

In the meantime, they say, doctors should prescribe more of the medications included in the guidelines recommended for pre-treatment of high blood sugar, high blood pressure and bad cholesterol.

Only 56% to 60% of the diabetes patients surveyed were taking metformin, an ACE inhibitor, or an angiotensin receptor blocker for high blood pressure or a statin for high cholesterol.

The source: https://www.medscape.com/viewarticle/952779?fbclid=IwAR2MbcW6ypyh_WEWsTeD9PadoEwSqLqkS1Pwm3upZA4mxYeYkz2SLZeem-Y#vp_1

New England Journal of Medicine: “Trends in Diabetes Treatment and Control in US Adults, 1999–2018.”

Michael Fang, Ph.D., postdoctoral fellow, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Elizabeth Selvin, Ph.D., professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.

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Translated by: Thuy Linh