Treatment Patterns and Glycemic Control Changes between NHANES III (1988-1994) and NHANES 1999-2002 among U.S. Adults Diagnosed with Type 2 Diabetes
Abstract Number: 1000-P
Authors: TAO FAN, CAROL E. KORO, STEVE J. BOWLIN, DONALD O. FEDDER
Institutions: Baltimore, MD; Collegeville, PA
Results: We explored differences in oral antidiabetic agents (OADs) and insulin usage and associated glycemic control rates (HbA1c < 7%) for the years 1988-94 to 1999-02 in the US diabetic population.We identified two adult samples, one each from NHANES III (n=1215) and NHANES 1999-02 (n=758), which reported a diagnosis of type II diabetes and had data on diabetes medication and HbA1c. We defined four therapeutic regimens: diet, insulin, OADs (monotherapy or combination), or OADs plus insulin.
We compared the age-adjusted (NHANES 1999-02 adjusted to NHANES III diabetic age distribution) and age-specific (20-44, 45-64, and 65+ years old) glycemic control rates for each regimen between the surveys. Compared to NHANES III, diabetic individuals in the 1999-02 survey were younger (61.3 and 59.0 years old, respectively), included more males (44.5 and 50.4%) and fewer non-Hispanic whites (74.4 and 61.8%), had a higher BMI (30.4 and 31.9 kg/m2) and longer disease duration (9.3 and 11.3 years). Diabetic individuals treated with diet decreased between the surveys (27.4 and 18.7%). Likewise, those using insulin decreased (24.2 and 14.0%), while those on OADs (45.4 and 57.4%) and OADs plus insulin (3.1 and 10.0%) increased. OADs changes were most pronounced in the 45-64 age group. Age adjusted glycemic control rates declined from 44.5% in NHANES III to 38.5% in NHANES 1999-02 (P<0.0001).Control rates declined from 44.3 to 39.8% in the 65+ age group, but increased from 15.8 to 16.2% in 20-44 years old, and from 39.9% to 44.0% in those 45-64 years old.
These most recent date showed that 61.5% of diabetic adults in the US have not acheived glycemic control and that early aggressive therapy is warranted in order to achieve glycemic goals.