Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018

This cross-sectional analysis evaluated U.S. adults with diagnosed diabetes participating in NHANES (1999–2018) to assess national trends in treatment and risk-factor control. Glycemic control (HbA₁c < 7%) rose to 57.4% by 2007–2010 but declined to 50.5% by 2015–2018. Lipid control (non-HDL cholesterol < 130 mg/dL) plateaued at 55.7%, and blood-pressure control (<140/90 mm Hg) declined from 74.2% to 70.4%. Simultaneous achievement of all three targets peaked at 24.9% in 2007–2010 and then stagnated. Despite increases in statin, ACE inhibitor/ARB, and metformin use through 2010, treatment rates leveled off thereafter. Use of combination therapy declined or plateaued in patients with uncontrolled metrics. Sociodemographic gaps in treatment were noted: younger adults, Mexican Americans, and uninsured individuals were less likely to receive therapy. The findings underscore a reversal in progress and suggest urgent need for renewed national strategies to improve diabetes management.

This cross-sectional analysis evaluated U.S. adults with diagnosed diabetes participating in NHANES (1999–2018) to assess national trends in treatment and risk-factor control. Glycemic control (HbA₁c < 7%) rose to 57.4% by 2007–2010 but declined to 50.5% by 2015–2018. Lipid control (non-HDL cholesterol < 130 mg/dL) plateaued at 55.7%, and blood-pressure control (<140/90 mm Hg) declined from 74.2% to 70.4%. Simultaneous achievement of all three targets peaked at 24.9% in 2007–2010 and then stagnated. Despite increases in statin, ACE inhibitor/ARB, and metformin use through 2010, treatment rates leveled off thereafter. Use of combination therapy declined or plateaued in patients with uncontrolled metrics. Sociodemographic gaps in treatment were noted: younger adults, Mexican Americans, and uninsured individuals were less likely to receive therapy. The findings underscore a reversal in progress and suggest urgent need for renewed national strategies to improve diabetes management.