Diabetes trends since 1999   (April 23, 2009)

The Annals of Internal Medicine has recently published a very intriguing article: Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage.

The authors reviewed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2006, and focused on diabetes as well as blood pressure and cholesterol levels. They evaluated 1733 diabetic adults with ages between 40 and 85 years. People were classified as having diabetes if they reported they had a diagnosis of diabetes, or if they had a A1C level greater than 7.0%, or if they reported having "borderline diabetes" (n = 198). 21.7% of those reporting "borderline diabetes" were taking insulin or oral medications for diabetes or had elevated A1C levels, so the authors appropriately assumed that the self-diagnosis of "borderline" was incorrect.

What did they find? First, the authors noted that the prevalence of diabetes increased from 11.8% (during the time frame of 1999 to 2000) to 13.7% (2005-2006). They also found that differences in A1C, BP, and cholesterol when looked at by race, ethnicity, and education persisted over the period studied, but differences decreased for those over 65. They point out that Medicare coverage after age 65 years may be associated with reductions in these differences, and they surmise that expanding insurance coverage in younger folks may be especially beneficial to improve care for black, Hispanic, and less educated adults. Their data is suggestive that better insurance might mean better outcomes, but it's only a suggestion.

But the survey found something much more exciting and more important, in my opinion.

The analysis found that diabetes control as measured by A1C levels improved dramatically from 1999 to 2006. The A1C dropped from 7.7 in 1999-2000 to 7.2 in 2001-2002 to 7.1 in 2003-2004 to 7.0 in 2005-2006. And the percentage of diabetic participants whose A1C was less than 7 rose from 38.1% to 55.0% to 57.8% to 59.1%.

This is absolutely spectacular, and confirms a suspicion that endocrinologists have had for years -- that the ability to control diabetes is improving. Reasons for the improved control are multiple:

* many new diabetes drugs have become available,

* new treatment algorithms exist for combining the use of multiple diabetes medications, including insulin,

* meal plans emphasizing carb counting as well as weight control are now widely used,

* and glucose monitoring has come into more wide-spread use.

Only one thing is still missing that would make the data look even better (besides fixing the health-care-financing mess): if we could only get the epidemic of obesity under control, then diabetes would be much less prevalent, and much easier to control.