- Fall 2004 -

Most People with Diabetes Do Not Meet Treatment Goals

Less than 12% of people with diagnosed diabetes meet the recommended goals for blood glucose, blood pressure and cholesterol despite a great deal of research showing that controlling these conditions dramatically delays or prevents diabetes complications. Moreover, the percentage of people who achieve these targets has changed little in the last decade, according to a study published recently in the Journal of the American Medical Association.

"More diabetes patients are taking medication to control their blood pressure and cholesterol, but too few are making needed lifestyle changes such as exercising, lowering dietary fat, and losing weight to control the risk factors for diabetes complications," notes author Dr. Catherine Cowie of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the National Institutes of Health.

The researchers compared data obtained from a nationally representative sample of U.S. adults age 20 years and older with diagnosed diabetes who took part in either the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994 or the NHANES conducted from 1999 to 2000.

Participants in the later survey, though similar in age and gender, were heavier, diagnosed with diabetes younger, and more likely to be using insulin along with oral drugs to treat their diabetes. Only 37% (compared to 44% in the earlier NHANES) were achieving the American Diabetes Association's (ADA) goal for blood glucose controlÑa hemoglobin A1c (HbA1c) blood test result of less than seven perfect. About 37% of participants in the later survey had HbA1c levels above eight percent, ADA's recommended "take action" level.

Diabetes is the main cause of kidney failure, limb amputations, and new onset blindness in adults and is a major cause of heart disease and stroke. Many clinical trials have proven that these complications can be dramatically reduced with good control of blood glucose, blood pressure and cholesterol. National campaigns such as the National Diabetes Education Program's Be Smart About Your Heart and Control the ABCs of Diabetes (HbA1c, Blood Pressure, and Cholesterol) have led to a wider awareness of the need to control the risk factors for diabetes complications. But more needs to be done, the study's authors conclude.

"We must redouble our efforts to empower patients and providers with information and tools to improve therapy and to provide incentives for the comprehensive care that has been proven effective in reducing diabetes complications," says coauthor Dr. Judith Fradkin, director of NIDDK's Diabetes, Endocrinology and Metabolic Diseases Division.