New Study Finds That Fewer Americans with Diabetes Have Control Over Their Blood Sugar

Possible complications from diabetes can be very serious, from stroke and heart disease to blindness and amputations. When the disease isn’t properly controlled, the risk of all of these issues is much higher. A new study finds that fewer Americans have their diabetes under control.

Researchers from the Johns Hopkins Bloomberg School of Public Health used a nationwide study to look at how well people with diabetes were controlling various aspects of the disease. They found that over the past decade, fewer people had their blood sugar and blood pressure under control. The findings were published in the New England Journal of Medicine.


Dr. Elizabeth Selvin, senior author and professor in the Bloomberg School’s Department of Epidemiology, says, “These are concerning findings. There has been a real decline in glycemic control from a decade ago, and overall, only a small proportion of people with diabetes are simultaneously meeting the key goals of glycemic control, blood pressure control, and control of high cholesterol.”

To conduct the study, the team looked at data from the U.S. government-supported National Health and Nutrition Examination Survey. Each year, the survey interviews and conducts clinical exams of about 5,000 Americans. For this study, the researchers included data from 6,653 people who took part between 1999 and 2018, were at least 20-years-old, were not pregnant, and had been diagnosed with diabetes.

When it came to blood sugar, the team found that the number of people who maintained HbA1c levels below 7.0% had risen from 44.0% between 1999 and 2002 to 57.4% between 2007 and 2010. However, the percentage then tailed off to 50.5 between 2015 and 2018.


The trend was similar for those maintaining control over blood pressure. Between 1999 and 2002, about 64.0% had a reading below 140/90 mmHg, which rose to 74.2% between 2011 and 2014. However, there was another drop in the 2015 to 2018 stretch, with the number going down to 70.4%.

There was some good news, though. Bad cholesterol control increased a bit over the past decade. Those who maintained non-HDL cholesterol lower than 130 mg/dl rose from 25.3% in 1999 through 2002 to 52.3% from 2007 to 2010. It was up to 55.7% from 2015 to 2018.

Those who maintained control over all three factors in the 1999 through 2002 period made up only 9.0% of participants. By 2007 through 2010, that rose to 24.9%. However, there was also a decrease during the 2015 to 2018 period, down to 22.2%.

Dr. Michael Fang, lead author and postdoctoral fellow at the Bloomberg School, says, “These trends are a wake-up call, since they mean that millions of Americans with diabetes are at higher risk for major complications. Our study suggests that worsening control of diabetes may already be having a detrimental effect at the national level.”


The researchers say two large clinical trials whose results were published in 2008 may have something to do with lower blood sugar control rates. The ACCORD and ADVANCE trials found that lowering HbA1c to very low levels didn’t result in the expected benefits. Some participants with very low levels even had increased risks of hypoglycemia.

Dr. Selvin explains, “As a result of these trials, what we may be seeing is that doctors of people with diabetes may have backed off a bit on glycemic control, with potentially damaging results.”

She did add that since then, more new and improved diabetes drugs have been developed. Such drugs should be beneficial for most people with diabetes if they can lower HbA1c levels without causing hypoglycemia.


When it comes to blood pressure, Selvin noted that there’s been a nationwide trend of fewer people maintaining that reading below 140/90 mmHg. The patients with diabetes appear to be no different.

In order to control your diabetes and prevent complications, the Centers for Disease Control and Prevention has a few tips. Follow a healthy eating plan, be physically active for at least 150 minutes each week, take medications as instructed and talk to your doctor if you experience any issues, keep appointments with your doctors, and don’t smoke. The CDC also says losing just 5-7% of your body weight can be beneficial if you’re overweight.

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