Trends and Disparities in Glycemic Control and Severe Hyperglycemia Among US Adults With Diabetes Using Insulin, 1988-2020.
Trends and Disparities in Glycemic Control and Severe Hyperglycemia Among US Adults With Diabetes Using Insulin, 1988-2020.
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使用胰岛素，1988 - 2020年，美国成年人中血糖控制和严重高血糖的趋势和差异。
DOI：
10.1001/jamanetworkopen.2022.47656
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发表时间：
2022-12-01
影响因子：
13.8
通讯作者：
Fang, Michael
中科院分区：
文献类型：
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作者：
Venkatraman, Siddharth;Echouffo-Tcheugui, Justin B.;Selvin, Elizabeth;Fang, Michael
本横断面研究使用来自国家健康和营养检查调查的数据来评估1988年至2020年美国诊断为使用胰岛素的糖尿病患者血糖控制和严重高血糖的趋势。在过去的30年里，使用胰岛素的美国成人糖尿病患者的血糖控制是否有所改善？在这项对2482名使用胰岛素的美国糖尿病成年人的横断面研究中，血糖控制的患病率（糖化血红蛋白水平<7%）保持不变（1988-1994年为29.2%，2017-2020年为27.5%）。使用胰岛素的墨西哥裔美国成年人比非西班牙裔白人成年人更不可能达到血糖控制，并且在研究期间差异增加。这项研究发现，在过去的30年里，美国成年糖尿病患者使用胰岛素的血糖控制停滞不前，种族和民族差异增加。在过去的几十年里，胰岛素的输送和配方已经取得了重大进展。目前尚不清楚这些改变是否改善了糖尿病患者的血糖控制。研究美国成年糖尿病患者使用胰岛素控制血糖和严重高血糖的趋势和差异。这项以人群为基础的横断面研究使用了1988-1994年和1999-2020年国家健康和营养检查调查（NHANES）的数据。参与者为未怀孕的美国成年人，年龄在20岁或以上，诊断为糖尿病，目前正在使用胰岛素。糖尿病的诊断和胰岛素的使用。采用logistic回归对血糖控制（糖化血红蛋白[HbA1c]水平<7%）和严重高血糖（HbA1c水平bbb10 %；将总血红蛋白百分比转换为总血红蛋白比例，乘以0.01；将转换为毫摩尔每摩尔，乘以10.93，减去23.50）的总体趋势、年龄、种族和民族趋势以及社会经济地位指标进行评估。分析纳入了样本权重，以解释某些人群的过采样和调查无反应。共有2482名使用胰岛素的糖尿病患者纳入分析（平均[SD]年龄，59.8[0.4]岁）；51.3%为男性，7.0%为墨西哥裔美国人，17.9%为非西班牙裔黑人，65.2%为非西班牙裔白人。从1988-1994年到2013-2020年，糖尿病患者接受胰岛素治疗并达到血糖控制的比例没有明显变化，从29.2% （95% CI, 22.6%-36.8%）到27.5% （95% CI, 21.7%-34.2%）。接受胰岛素治疗的墨西哥裔美国成年人比非西班牙裔白人成年人实现血糖控制的可能性更小，并且在研究期间差异越来越大。2013-2020年，患有严重高血糖的成人比例没有显著变化，为14.6% （95% CI, 12.0-17.5）。墨西哥裔美国人或非西班牙裔黑人、无保险或家庭收入较低的成年人患严重高血糖的比例最高。在过去30年NHANES数据的基于人群的横断面研究中，接受胰岛素治疗的美国成年糖尿病患者的血糖控制停滞不前，种族和民族差异增加。努力改善获得胰岛素的途径可以优化血糖控制，减少这一人群的差异。
This cross-sectional study uses data from the National Health and Nutrition Examination Survey to evaluate trends in glycemic control and severe hyperglycemia among US patients diagnosed with diabetes using insulin from 1988 to 2020. Has glycemic control improved among US adults with diabetes using insulin over the past 30 years? In this cross-sectional study of 2482 US adults with diabetes using insulin, the prevalence of glycemic control (glycated hemoglobin level <7%) remained unchanged (29.2% in 1988-1994 to 27.5% in 2017-2020). Mexican American adults using insulin were less likely than non-Hispanic White adults to achieve glycemic control, and disparities increased during the study period. This study found that over the past 3 decades, glycemic control stagnated and racial and ethnic disparities increased among US adults with diabetes using insulin. There have been major advances in insulin delivery and formulations over the past several decades. It is unclear whether these changes have resulted in improved glycemic control for patients with diabetes. To characterize trends and disparities in glycemic control and severe hyperglycemia in US adults with diabetes using insulin. This serial population-based cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) between 1988-1994 and 1999-2020. Participants were nonpregnant US adults aged 20 years or older who had a diagnosis of diabetes and were currently using insulin. Diabetes diagnosis and use of insulin. Trends in glycemic control (glycated hemoglobin [HbA1c] level <7%) and severe hyperglycemia (HbA1c level >10%; to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert to millimoles per mole, multiply by 10.93 and subtract by 23.50) overall and by age, race and ethnicity, and indicators of socioeconomic status were evaluated using logistic regression. Analyses incorporated sample weights to account for oversampling of certain populations and survey nonresponse. There were 2482 participants with diabetes using insulin included in the analyses (mean [SD] age, 59.8 [0.4] years); 51.3% were men, 7.0% were Mexican American individuals, 17.9% were non-Hispanic Black individuals, and 65.2% were non-Hispanic White individuals. From 1988-1994 to 2013-2020, the proportion of patients with diabetes who received insulin and achieved glycemic control did not significantly change, from 29.2% (95% CI, 22.6%-36.8%) to 27.5% (95% CI, 21.7%-34.2%). Mexican American adults who received insulin were less likely than non-Hispanic White adults to achieve glycemic control, and disparities increased during the study period. The proportion of adults with severe hyperglycemia did not significantly change and was 14.6% (95% CI, 12.0-17.5) in 2013-2020. Adults who were Mexican American or non-Hispanic Black, were uninsured, or had low family income had the highest prevalence of severe hyperglycemia. In this population-based cross-sectional study of NHANES data over the past 3 decades, glycemic control stagnated and racial and ethnic disparities increased among US adults with diabetes who received insulin. Efforts to improve access to insulin may optimize glycemic control and reduce disparities in this population.
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影响因子：
5.4
作者：
Isaacs, Diana;Bellini, Natalie J.;Close, Kelly L.
通讯作者：
Close, Kelly L.
影响因子：
16.2
作者：
Taha, Mohamad B.;Valero-Elizondo, Javier;Nasir, Khurram
通讯作者：
Nasir, Khurram
影响因子：
16.2
作者：
Benoit, Stephen R.;Hora, Israel;Imperatore, Giuseppina
通讯作者：
Imperatore, Giuseppina
DOI：
10.2337/cd22-as01
发表时间：
2022-01-01
期刊：
Clinical diabetes : a publication of the American Diabetes Association
影响因子：
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作者：
通讯作者：
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影响因子：
16.2
作者：
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