The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010
Open accessAbstract
OBJECTIVE: To determine the prevalence of people with diabetes who meet hemoglobin A1c (A1C), blood pressure (BP), and LDL cholesterol (ABC) recommendations and their current statin use, factors associated with goal achievement, and changes in the proportion achieving goals between 1988 and 2010. RESEARCH DESIGN AND METHODS: Data were cross-sectional from the National Health and Nutrition Examination Surveys (NHANES) from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Participants were 4,926 adults aged ≥20 years who self-reported a previous diagnosis of diabetes and completed the household interview and physical examination (n = 1,558 for valid LDL levels). Main outcome measures were A1C, BP, and LDL cholesterol, in accordance with the American Diabetes Association recommendations, and current use of statins. RESULTS: In 2007–2010, 52.5% of people with diabetes achieved A1C <7.0% (<53 mmol/mol), 51.1% achieved BP <130/80 mmHg, 56.2% achieved LDL <100 mg/dL, and 18.8% achieved all three ABCs. These levels of control were significant improvements from 1988 to 1994 (all P < 0.05). Statin use significantly increased between 1988–1994 (4.2%) and 2007–2010 (51.4%, P < 0.01). Compared with non-Hispanic whites, Mexican Americans were less likely to meet A1C and LDL goals (P < 0.03), and non-Hispanic blacks were less likely to meet BP and LDL goals (P < 0.02). Compared with non-Hispanic blacks, Mexican Americans were less likely to meet A1C goals (P < 0.01). Younger individuals were less likely to meet A1C and LDL goals. CONCLUSIONS: Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups. Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes-related morbidity and mortality.
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Written from the paper’s full text.
TL;DR
In NHANES 1988–2010, achievement of A1C, blood pressure, and LDL goals among U.S. adults with self-reported diabetes improved substantially, but remained suboptimal. In 2007–2010, 52.5% met A1C <7.0%, 51.1% met BP <130/80 mmHg, 56.2% met LDL <100 mg/dL, and only 18.8% met all three ABC goals.
Key findings
- In 2007–2010, 52.5% achieved A1C <7.0% (<53 mmol/mol), 51.1% achieved BP <130/80 mmHg, 56.2% achieved LDL <100 mg/dL, and 18.8% achieved all three ABC goals; these were significant improvements from 1988–1994 (all P < 0.05).
- Statin use increased significantly from 4.2% in 1988–1994 to 51.4% in 2007–2010 (P < 0.01); in 2007–2010, 40.1% were taking a statin and achieved LDL <100 mg/dL.
- Disparities persisted: Mexican Americans were less likely than non-Hispanic whites to meet A1C and LDL goals (P < 0.03), non-Hispanic blacks were less likely than non-Hispanic whites to meet BP and LDL goals (P < 0.02), and Mexican Americans were less likely than non-Hispanic blacks to meet A1C goals (P < 0.01); younger individuals were less likely to meet A1C and LDL goals.
- Less stringent goals were more often met: A1C <8.0% (<64 mmol/mol) rose from 60.1% in 1988–1994 to 77.9% in 2007–2010; BP <140/90 mmHg rose from 62.0% to 72.0%; LDL <100 mg/dL rose from 9.9% to 56.2%; all three ABC goals rose from 1.7% to 18.8% (all P < 0.01 for comparisons with 2007–2010).
Methods
- Cross-sectional National Health and Nutrition Examination Surveys (NHANES) from 1988–1994, 1999–2002, 2003–2006, and 2007–2010; participants were 4,926 adults aged ≥20 years who self-reported a previous diabetes diagnosis and completed the household interview and physical examination (n = 1,558 for valid LDL levels).
- Main outcomes were A1C, BP, and LDL cholesterol according to ADA recommendations, plus current statin use; estimates were age and sex standardized to the 2007–2010 NHANES population with diabetes, used sample weights, accounted for cluster sampling with SUDAAN, and tested changes over time with two-sided t tests (P ≤ 0.05 vs. 2007–2010), with no adjustment for multiple comparisons.
- A1C was standardized to the Diabetes Control and Complications Trial method; BP was measured with a standardized mercury sphygmomanometer after 5 minutes of rest, averaging up to four readings excluding the first; LDL was calculated for properly fasted participants as total cholesterol − HDL − triglycerides/5; eGFR was estimated with the Chronic Kidney Disease Epidemiology Collaboration equation.
Limitations
- Stated: the small fasting sample made some subgroup LDL estimates unreliable; in NHANES 1988–1994, insulin users were not instructed to fast, so LDL estimates for those years include few insulin users; there was a discrepancy between self-reported lipid medication use and documented statin use; and an unexplained population-wide A1C increase in NHANES 2007–2010 may mean the percentage achieving A1C <7.0% is underestimated.
- Stated: no information was available on medication compliance to further assess individualization of treatment, and the analysis only reports ABC control for individuals who self-reported diabetes.
- Evident from the text: the cross-sectional design cannot establish causality; self-reported diabetes, CVD history, and medication use may be misclassified; and the lack of adjustment for multiple comparisons increases the possibility of false-positive subgroup findings.
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Cites
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Claims the paper makes
0 of 12 cited sources checked · 0 supported · 0 flagged
- Findingown data
Among US adults with diagnosed diabetes in 2007-2010, 72.0% achieved BP <140/90 mmHg.
“The proportion with BP <140/90 mmHg was 72.0%”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
Among US adults aged ≥20 years with self-reported diagnosed diabetes in 2007-2010, 52.5% achieved an A1C <7.0% (<53 mmol/mol).
“In 2007–2010, 52.5% of people with diabetes achieved A1C <7.0% (<53 mmol/mol)”
- Also stated in: § A1C · plain
“In 2007–2010, the overall prevalence of persons with diabetes achieving A1C <7.0% (<53 mmol/mol) was 52.5% (Fig. 1 and Table 1).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Also stated in: § A1C · plain
- Findingown data
The prevalence of achieving A1C <7.0% among US adults with diabetes significantly increased from 1988-1994 to 2007-2010.
“Over time, the prevalence of subjects with diabetes who achieved an A1C <7.0% (<53 mmol/mol) significantly increased (1988–1994 and 1999–2002 vs. 2007–2010 [P < 0.01 and P < 0.05, respectively]; Fig. 1 and Table 1).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
Among US adults with diagnosed diabetes in 2007-2010, 77.9% achieved A1C <8.0% (<64 mmol/mol).
“The proportion of participants with diabetes achieving A1C <8.0% (<64 mmol/mol) was 77.9% in 2007–2010”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
Among US adults aged ≥20 years with self-reported diagnosed diabetes in 2007-2010, 56.2% achieved LDL <100 mg/dL.
“56.2% achieved LDL <100 mg/dL”
- Also stated in: § LDL cholesterol · plain
“In 2007–2010, the overall prevalence of achieving LDL <100 mg/dL was 56.2% (Fig. 1 and Table 3).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Also stated in: § LDL cholesterol · plain
- Findingown data
Among US adults with diagnosed diabetes in 2007-2010, 51.4% used statins.
“In 2007–2010, the prevalence of statin use among adults with diabetes was 51.4% (Fig. 1 and Table 3).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
- Findingown data
In 2007-2010, meeting the LDL <100 mg/dL goal was more frequent for older compared with younger individuals with diabetes.
“Meeting the LDL goal was more frequent for older (P < 0.01) compared with younger individuals”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Findingown data
In 2007-2010, people with diabetes not taking antihypertensive medications were more likely to achieve the BP goal compared with those taking medication.
“People not taking antihypertensive medications were more likely to achieve the BP goal compared with those taking medication (P < 0.0001).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, the prevalence of achieving BP <130/80 mmHg gradually decreased with increasing age.
“The prevalence of achieving BP <130/80 mmHg gradually decreased with increasing age (P < 0.0001)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
The prevalence of achieving A1C <8.0% increased from 60.1% in 1988-1994 to 77.9% in 2007-2010.
“Improvement in meeting A1C <8.0% (<64 mmol/mol) was even more marked than for A1C <7.0% (<53 mmol/mol), with prevalence significantly increased between 1988–1994 (60.1%) and 2007–2010 (77.9%) and between 1999–2002 (66.3%) and 2007–2010 (all P < 0.01; Fig. 1).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
In 2007-2010, statin use was more common among older adults (≥75 vs 20-49 years) with diabetes.
“Statin use was more common among older adults (≥75 vs. 20–49 years), those with a longer time since diagnosis (<5 vs. ≥20 years), and those with a history of heart disease (all P < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
- Findingown data
In 2007-2010, meeting the BP goal did not significantly differ by diabetes medication use or duration of diabetes.
“Meeting the BP goal did not significantly differ by diabetes medication use or duration of diabetes.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
The proportion of persons who met all three ABC goals (18.8%) was much lower than the proportion that met each individual ABC goal (51-56%).
“The proportion of persons who met all three ABC goals (18.8%) was much lower than the proportion that met each individual ABC goal (51–56%).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Findingown data
In 2007-2010, meeting the LDL <100 mg/dL goal was more frequent for high school graduates compared with those without a high school degree.
“and for high school graduates compared with those without a high school degree (P = 0.045).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Findingown data
The prevalence of achieving LDL <100 mg/dL improved from 9.9% in 1988-1994 to 56.2% in 2007-2010.
“During 1988–2010, the prevalence of achieving LDL <100 mg/dL dramatically improved, from 9.9% in 1988–1994, 35.3% in 1999–2002, and 48.0% in 2003–2006 to 56.2% in 2007–2010 (P < 0.01 for all estimates compared with 2007–2010).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
The prevalence of achieving BP <140/90 mmHg improved from 62.0% in 1988-1994 to 72.0% in 2007-2010.
“The prevalence of people with diabetes achieving BP <140/90 mmHg also significantly improved between 1988–1994 (62.0%) and 2007–2010 (72.0%) and between 1999–2002 (63.3%) and 2007–2010 (all P < 0.01; Fig. 1).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
Achievement of all three ABC goals improved from 1.7% in 1988-1994 to 18.8% in 2007-2010.
“Achieving all three ABC goals significantly improved between 1988–1994 (1.7%) and 2007–2010 (18.8%) and between 1999–2002 (7.1%) and 2007–2010 (18.8%; all P < 0.01).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
The prevalence of achieving BP <130/80 mmHg improved from 33.2% in 1988-1994 to 51.1% in 2007-2010.
“Between 1988 and 2010, the proportion of people who achieved BP <130/80 mmHg significantly improved, with 33.2% in 1988–1994, 38.1% in 1999–2002, 44.2% in 2003–2006, and 51.1% in 2007–2010 meeting the goal (P < 0.05 for all estimates compared with 2007–2010).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
In 2007-2010, achieving BP <130/80 mmHg was greater for individuals with a college degree compared with high school graduates.
“and for individuals with a college degree compared with high school graduates (P = 0.049).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, achieving BP <130/80 mmHg was greater for non-Hispanic whites than non-Hispanic blacks.
“was greater for non-Hispanic whites than non-Hispanic blacks (P = 0.016)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, the prevalence of meeting A1C <7.0% was higher for adults with diabetes aged ≥75 years than for those aged 20-49 years.
“The prevalence of meeting the A1C goal <7.0% (<53 mmol/mol) was higher for those aged ≥75 years than for those aged 20–49 years (P = 0.022)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, people with diabetes not taking any diabetes medications more often achieved A1C <7.0% than those taking insulin or oral medication.
“People not taking any diabetes medications (vs. insulin or oral medication), those with shorter disease duration (<5 vs. ≥20 years), and those without retinopathy more often achieved A1C <7.0% (<53 mmol/mol; P < 0.001 for all).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, statin use was more common among adults with diabetes and a history of heart disease.
“Statin use was more common among older adults (≥75 vs. 20–49 years), those with a longer time since diagnosis (<5 vs. ≥20 years), and those with a history of heart disease (all P < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
- Findingown data
In 2007-2010, meeting the LDL <100 mg/dL goal was more frequent for men compared with women.
“for men compared with women (P = 0.003)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Findingown data
Statin use among US adults with diabetes increased from 4.2% in 1988-1994 to 51.4% in 2007-2010.
“Statin use significantly increased during 1988–2010 with 4.2% taking a statin in 1988–1994, 28.8% in 1999–2002, 44.1% in 2003–2006, and 51.4% in 2007–2010 (P < 0.01 for all estimates compared with 2007–2010; Fig. 1).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
- Findingown data
In 2007-2010, meeting the LDL <100 mg/dL goal was more frequent for non-Hispanic whites compared with Mexican Americans, all Hispanics, or non-Hispanic blacks.
“for non-Hispanic whites compared with Mexican Americans, all Hispanics, or non-Hispanic blacks (all P < 0.02)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Findingown data
In 2007-2010, people with diabetes without retinopathy more often achieved A1C <7.0%.
“People not taking any diabetes medications (vs. insulin or oral medication), those with shorter disease duration (<5 vs. ≥20 years), and those without retinopathy more often achieved A1C <7.0% (<53 mmol/mol; P < 0.001 for all).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, statin use was more common among adults with diabetes and a longer time since diagnosis (<5 vs ≥20 years).
“Statin use was more common among older adults (≥75 vs. 20–49 years), those with a longer time since diagnosis (<5 vs. ≥20 years), and those with a history of heart disease (all P < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
- Findingown data
In 2007-2010, meeting A1C <7.0% was greater for non-Hispanic whites and non-Hispanic blacks than for Mexican Americans.
“was greater for non-Hispanic whites and non-Hispanic blacks than for Mexican Americans (P < 0.03 for both).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Findingown data
In 2007-2010, people with diabetes and shorter disease duration (<5 vs ≥20 years) more often achieved A1C <7.0%.
“People not taking any diabetes medications (vs. insulin or oral medication), those with shorter disease duration (<5 vs. ≥20 years), and those without retinopathy more often achieved A1C <7.0% (<53 mmol/mol; P < 0.001 for all).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Interpretationreasoning
The greatest potential to reduce type 2 diabetes-related complications may lie in focusing on controlling A1C, BP, and LDL collectively.
“The greatest potential to reduce type 2 diabetes-related complications may lie in focusing on controlling A1C, BP, and LDL collectively.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Improvements in ABC control during the past two decades likely derive from new and improved therapeutic agents and increasing scientific evidence of risk factor control benefits that increased their use.
“Improvements in ABC control during the past 2 decades likely derive from new and improved therapeutic agents and increasing scientific evidence of risk factor control benefits that increased their use.”
Quote in the paperSubstantial claim - Interpretationnone given
Falling rates of amputation, end-stage renal disease, and death among those with diabetes attest to the effect of the improved control of risk factors for complications reported here.
“Falling rates of amputation, end-stage renal disease, and death among those with diabetes attest to the effect of the improved control of the risk factors for complications we report here.”
Quote in the paperNot a substantial claim - Premisecitation
A reduction in hemoglobin A1c and blood pressure levels significantly reduces microvascular complications in people with diabetes.
“However, that a reduction in hemoglobin A1c (A1C) and blood pressure (BP) levels significantly reduces microvascular complications has been well established (2).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] UK Prospective Diabetes Study (UKPDS) Group, 1998, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), Lancet source
Not checked in the free run.
- Interpretationreasoning
The steady improvement documented by this study portends further reductions in the proportion with complications among those with diabetes.
“Thus, the steady improvement documented by our study portends further reductions in the proportion with complications among those with diabetes.”
Quote in the paperNot a substantial claim - Interpretationown data
Suboptimal ABC control may be complicated by biological unattainability of ADA recommendations for some patients due to severity of disease or other complications.
“First, achieving ADA recommendations may be biologically unattainable for some patients due to severity of disease or other complications.”
Quote in the paperSubstantial claim - Premisecitation
A population-wide increase in A1C values was observed in the NHANES 2007-2010 study period compared with the 1999-2006 study period.
“Finally, a population-wide increase in A1C values was observed in the NHANES 2007–2010 study period compared with the 1999–2006 study period (25).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25]
Not checked in the free run.
- Study design and conductreasoning
Because participants taking insulin were not instructed to fast in NHANES 1988-1994, the estimates for meeting LDL goals in those years include few persons who were taking insulin.
“Because participants taking insulin were not instructed to fast in NHANES 1988–1994, the estimates for meeting LDL goals in those years include few persons who were taking insulin.”
Quote in the paperSubstantial claim- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Study design and conductreasoning
There was a discrepancy between self-reported lipid medication use and documentation of statin use.
“There was a discrepancy between self-reported lipid medication use and documentation of statin use; this may have resulted because lipid medication use was only reported among those who were told by a physician to take medication because participants were unaware of their statin use and it was not reported or because prescription medication bottles were not brought to the MEC.”
Quote in the paperSubstantial claim- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
- Study design and conductown data
The percentage achieving A1C <7.0% may be underestimated in the current study for the 2007-2010 period.
“The estimates for the 2007–2010 study period should be interpreted with consideration of these findings; the percentage achieving A1C <7.0% (<53 mmol/mol) may be underestimated in the current study.”
Quote in the paperSubstantial claim - Study design and conductown data
The cause for the population-wide increase in A1C values in NHANES 2007-2010 compared with 1999-2006 could not be identified.
“After careful evaluation of the data, a cause for the shift could not be identified.”
Quote in the paperSubstantial claim - Study design and conductnone given
The study used a nationally representative sample allowing generalization to the U.S. adult noninstitutionalized population.
“A strength of this study was the use of a nationally representative sample allowing generalization to the U.S. adult noninstitutionalized population.”
Quote in the paperSubstantial claim - Study design and conductnone given
Among those taking insulin, demographic characteristics and duration of diabetes were similar by fasting status.
“However, among those taking insulin, demographic characteristics and duration of diabetes were similar by fasting status.”
Quote in the paperSubstantial claim - Study design and conductcitation
A1C was standardized to the Diabetes Complications and Control Trial method.
“A1C was standardized to the Diabetes Complications and Control Trial method (9).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] Centers for Disease Control and Prevention, National Center for Health Statistics, 2008
Not checked in the free run.
- Premisecitation
Selected findings in the current study were replicated in a previous study using data from NHANES 1999-2006.
“Results from Look AHEAD generally agree with our findings, and selected findings in the current study were replicated in a previous study using data from NHANES 1999–2006 (20).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] McWilliams, 2009, Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage, Ann Intern Med source
Not checked in the free run.
- Study design and conductown data
The small number of individuals in the fasting sample made some subgroup LDL estimates unreliable.
“One limitation is that the small number of individuals in the fasting sample made some subgroup LDL estimates unreliable.”
Quote in the paperNot a substantial claim- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- The quote only partly states this claim. 4
- May combine two claims. 11
- Classified as probably not a substantial claim. 11
The quote only partly states this claim.
Findingown dataAmong US adults aged ≥20 years with self-reported diagnosed diabetes in 2007-2010, 51.1% achieved BP <130/80 mmHg.
“51.1% achieved BP <130/80 mmHg”
- Also stated in: § BP · plain
“In 2007–2010, the prevalence of individuals with diabetes having BP <130/80 mmHg was 51.1% (Fig. 1 and Table 2).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Also stated in: § BP · plain
The quote only partly states this claim.
Findingown dataAmong US adults aged ≥20 years with self-reported diagnosed diabetes in 2007-2010, 18.8% achieved all three ABC goals.
“18.8% achieved all three ABCs”
- Also stated in: § All three ABCs · plain
“In 2007–2010, 18.8% of people achieved all three ABC goals (Fig. 1).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Also stated in: § All three ABCs · plain
The quote only partly states this claim.
Findingown dataIn 2007-2010, 40.1% of adults with diabetes were taking a statin and achieved LDL <100 mg/dL.
“In 2007–2010, 40.1% of adults were taking a statin and achieved LDL <100 mg/dL.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
- Rests on an assumption: Documented statin use from medication bottles accurately reflects actual statin use.
The quote only partly states this claim.
Findingown dataIn 2007-2010, 81.2% of US adults with diabetes did not achieve all three ABC goals.
“Almost half of Americans with diabetes did not meet each ABC goal, and 81.2% did not achieve all three goals.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
May combine two claims.
PremisecitationPrior NHANES data indicated that the prevalence of achieving an A1C <7.0% increased from 44% in 1988-1994 to 57% in 2003-2006, and achieving a BP <130/80 mmHg increased from 29% to 46% during the same interval.
“National Health and Nutrition Examination Survey (NHANES) data indicate that the prevalence of achieving an A1C <7.0% (<53 mmol/mol) increased from 44% in 1988–1994 to 57% in 2003–2006; achieving a BP <130/80 mmHg increased from 29 to 46% during the same interval (5,6).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [5] Cheung, 2009, Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006, Am J Med source
Not checked in the free run.
- cites [6] Saydah, 2004, Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes, JAMA source
Not checked in the free run.
May combine two claims.
PremisecitationBlood pressure and lipid control substantially reduce cardiovascular disease, the major cause of death for individuals with diabetes.
“In addition, BP and lipid control substantially reduce cardiovascular disease (CVD), the major cause of death for individuals with diabetes (2).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] UK Prospective Diabetes Study (UKPDS) Group, 1998, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), Lancet source
Not checked in the free run.
May combine two claims.
Interpretationown dataDespite significant improvement during the past decade, achieving the ABC goals remains suboptimal among US adults with diabetes, particularly in some minority groups.
“Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Rests on an assumption: The fasting subsample used for LDL estimates is representative of the full diabetic population.
May combine two claims.
InterpretationreasoningYounger adults with diabetes have more to gain from risk factor control because their life expectancy is longer and the potential for complications increases with the duration of diabetes.
“Nevertheless, younger adults have more to gain from risk factor control because their life expectancy is longer and the potential for complications increases with the duration of diabetes.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenSide effects of antihypertensives and statins may limit their use and therefore the attainment of treatment goals.
“Side effects of antihypertensives (electrolyte disturbances, renal dysfunction, orthostatic hypotension) and statins (musculoskeletal) may also limit their use and, therefore, the attainment of the treatment goals.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningBecause goals are increasingly being tailored on the basis of individual factors, it is not expected or desirable that everyone with diabetes should attain these targets.
“Finally, because goals are increasingly being tailored on the basis of individual factors, it is not expected or desirable that everyone with diabetes should attain these targets.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationThe American Diabetes Association recommends that most adults with diabetes achieve an A1C <7.0%, BP <130/80 mmHg, and LDL cholesterol <100 mg/dL.
“On the basis of this research, the American Diabetes Association (ADA) recommends that most adults with diabetes achieve an A1C <7.0% (<53 mmol/mol), BP <130/80 mmHg, and LDL cholesterol <100 mg/dL (ABCs) (3).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] American Diabetes Association, 2011, Standards of medical care in diabetes—2011, Diabetes Care source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S4 (based).
Interpretationnone givenIndividuals with diabetes may lack self-management skills or the resources necessary for adherence to demanding self-care regimens, often involving polypharmacy and lifestyle change.
“Second, individuals may lack self-management skills or the resources necessary for adherence to demanding self-care regimens, often involving polypharmacy, and lifestyle change.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductcitationAll statistical analyses used sample weights adjusted for nonresponse and noncoverage and accounted for the cluster sampling design using SUDAAN.
“All statistical analyses used sample weights (adjusted for nonresponse and noncoverage) and accounted for the cluster sampling design using SUDAAN (SUDAAN User’s Manual, Release 9.2, 2008; Research Triangle Institute).”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIn the UKPDS, tight glycemic control alone in patients with newly diagnosed type 2 diabetes yielded a nonsignificant 16% decrease in CVD events and a significant 25% reduction in microvascular events.
“In the UKPDS, tight glycemic control alone in patients with newly diagnosed type 2 diabetes yielded a nonsignificant 16% decrease in CVD events and a significant 25% reduction in microvascular events (2).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] UK Prospective Diabetes Study (UKPDS) Group, 1998, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), Lancet source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitationBP was measured using a standardized mercury sphygmomanometer after the participant rested quietly for 5 minutes, and up to four readings were averaged excluding the first measure.
“BP was measured using a standardized mercury sphygmomanometer after the participant rested quietly for 5 minutes (9). Up to four readings were taken and were averaged, excluding the first measure (9).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] Centers for Disease Control and Prevention, National Center for Health Statistics, 2008
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenMultiple clinical outcomes were assessed using standardized procedures.
“Multiple clinical outcomes were assessed using standardized procedures, which allowed us to better characterize diabetes control.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenNo adjustment was made for multiple comparisons.
“No adjustment was made for multiple comparisons.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataResults were age and sex standardized to the 2007-2010 NHANES population with diabetes.
“To compare study characteristics and the proportion who met ABC goals, results were age and sex standardized to the 2007–2010 NHANES population with diabetes using the age categories of 20–39 (7.9%), 40–59 (38.3%), and ≥60 (53.8%) years.”
Quote in the paperSubstantial claim- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationSerum creatinine was calibrated across study years to reflect changes in assay methods.
“serum creatinine was calibrated across study years to reflect changes in assay methods (12).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] National Center for Health Statistics. Laboratory manual for creatinine [Internet], 2008. Available from http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/lab_methods_05_06.htm. Accessed 15 December 2012
Not checked in the free run.
May combine two claims.
PremisecitationOnly 7% of people with diabetes in 1999-2002 and 12% in 2003-2006 met all three ABC goals.
“Only 7% of people with diabetes in 1999–2002 and 12% in 2003–2006 met all three ABC goals (5).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Cheung, 2009, Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006, Am J Med source
Not checked in the free run.
May combine two claims.
PremisecitationIn the Steno-2 Study, a randomized controlled trial among individuals with diabetes and microalbuminuria, hazard ratios were significantly reduced (0.41 for CVD events and 0.54 for overall mortality) in intensively treated participants compared with standard treatment.
“In contrast, the Steno-2 Study, a randomized controlled trial among individuals with diabetes and microalbuminuria, tested a multifactorial intensive intervention targeting ABC control, aspirin therapy, diet, and physical activity. Hazard ratios were significantly reduced (0.41 for CVD events and 0.54 for overall mortality) in intensively treated participants compared with participants who”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductnone givenNo information was available on medication compliance to further assess individualization of treatment.
“No information was available on medication compliance to further assess individualization of treatment.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
“Participants were adults aged ≥20 years who answered “yes” when asked whether a physician or other health care professional ever told them that they had diabetes”
“This analysis only reports ABC control for individuals who self-reported diabetes.”
The paper relies on this without support.
The fasting subsample used for LDL estimates is representative of the full diabetic population.
“Estimates for the prevalence of achieving all three goals were based on the fasting sample.”
“One limitation is that the small number of individuals in the fasting sample made some subgroup LDL estimates unreliable.”
The paper relies on this without support.
Documented statin use from medication bottles accurately reflects actual statin use.
“Participants were asked to report prescription medications they had taken in the past 30 days and to bring medication bottles to the examination, where the information was documented.”
“There was a discrepancy between self-reported lipid medication use and documentation of statin use; this may have resulted because lipid medication use was only reported among those who were told by a physician to take medication because participants were unaware of their statin use and it was not reported or because prescription medication bottles were not brought to the MEC.”
The paper relies on this without support.
The age and sex standardization to the 2007–2010 NHANES diabetic population yields valid comparisons across survey periods.
“To compare study characteristics and the proportion who met ABC goals, results were age and sex standardized to the 2007–2010 NHANES population with diabetes using the age categories of 20–39 (7.9%), 40–59 (38.3%), and ≥60 (53.8%) years.”
The paper relies on this without support.
The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
“LDL levels were calculated for people who had fasted properly (≥8 to <24 h) using the following formula: [LDL cholesterol = (total cholesterol) – (HDL cholesterol) – (triglycerides/5)].”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Among patients with type 2 diabetes who initiate basal insulin, only about 30% achieve their individual glycaemic target, primarily because fear of hypoglycaemia limits proper titration.
“Among patients with type 2 diabetes who initiate BI, only about 30% achieve their individual glycaemic target, primarily because a fear of hypoglycaemia limits proper titration.10,13”
From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [13]
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- Authors
- Stark Casagrande, S., Fradkin, J. E., Saydah, S. H., Rust, K. F., & Cowie, C. C.
- Affiliations
- Social & Scientific Systems, Inc., Silver Spring, Maryland
- National Institutes of Health (US)
- Centers for Disease Control and Prevention (US)
- Westat (United States) (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2013-07-11
- Volume
- 36
- Issue
- 8
- Pages
- 2271-2279
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3714503
- OpenAlex
- W2007221722
- Semantic Scholar
- 8cb36330575829369601478e5e4fdb84742299e0
- Cited by
- 719
- References
- 19
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 14 · 2023: 31 · 2022: 41 · 2021: 52 · 2020: 60 · 2019: 70 · 2018: 88 · 2017: 82 · 2016: 85 · 2015: 92 · 2014: 54 · 2013: 26
- FWCI
- 67.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (GS-10F-0381L)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes mellitus, glycemic control, HbA1c, blood pressure control, LDL cholesterol, statin use, racial and ethnic disparities, Mexican Americans, non-Hispanic blacks, NHANES, diabetes complications prevention, cardiovascular risk reduction, young adults
- MeSH terms
- Adult, Black or African American, Blood Pressure, Cross-Sectional Studies, Diabetes Mellitus, Goals, Glycated Hemoglobin, Humans, Cholesterol, LDL, Middle Aged, Nutrition Surveys, United States, Prevalence, Mexican Americans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, White People
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.
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