Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018.
Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018.
复制标题
DOI：
10.1056/nejmsa2032271
复制
发表时间：
2021-06-10
期刊：
影响因子：
--
通讯作者：
Selvin E
中科院分区：
文献类型：
--
作者：
Fang M;Wang D;Coresh J;Selvin E
记录糖尿病治疗和风险因素控制的当前趋势可以为公共卫生政策和规划提供信息。我们对参加国家健康和营养检查调查（NHANES）的美国糖尿病成人数据进行了横断面分析，以评估1999年至2018年糖尿病治疗和风险因素控制的国家趋势。从1999年到2010年初，参与者的糖尿病控制有所改善，但随后停滞不前并下降。在2007-2010年期间和2015-2018年期间，成年NHANES糖尿病参与者中血糖控制（糖化血红蛋白水平<7%）的百分比从57.4%（95%置信区间[CI]，52.9至61.8）下降到50.5%（95% CI，45.8至55.3）。在21世纪初血脂控制（非高密度脂蛋白胆固醇水平，<130 mg/dl）得到重大改善后，从2007-2010年（52.3%; 95% CI，49.2至55.3）到2015-2018年（55.7%; 95% CI，50.8至60.5）的改善最小。从2011-2014年到2015-2018年，血压控制（<140/90 mm Hg）的参与者百分比从74.2%（95% CI，70.7至77.4）下降到70.4%（95% CI，66.7至73.8）。同时实现所有三个目标的参与者比例在2010年后趋于稳定，2015-2018年为22.2%（95%CI，17.9至27.3）。使用任何降糖药物或任何降压药物的参与者的百分比在2010年后没有变化，而使用他汀类药物的百分比在2014年后趋于稳定。2010年后，联合治疗在血压不受控制的参与者中的使用有所下降，而血糖控制不佳的参与者则趋于稳定。从1999年到21世纪10年代初，经过十多年的进展，NHANES成年糖尿病患者的血糖和血压控制下降，而血脂控制趋于平稳。（由国家心脏，肺和血液研究所资助。
Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning. We conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018. Diabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007–2010 period and the 2015–2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non–high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007–2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015–2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011–2014 to 2015–2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015–2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure–lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control. After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off. (Funded by the National Heart, Lung, and Blood Institute.)