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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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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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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The proportion with BP <140/90 mmHg was 72.0%”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > BP
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > RESULTS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Also stated in: § A1C · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > A1C
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The proportion of participants with diabetes achieving A1C <8.0% (<64 mmol/mol) was 77.9% in 2007–2010”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > A1C
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > RESULTS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In 2007–2010, the prevalence of statin use among adults with diabetes was 51.4% (Fig. 1 and Table 3).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > Statin use
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meeting the LDL goal was more frequent for older (P < 0.01) compared with younger individuals”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > LDL cholesterol
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“People not taking antihypertensive medications were more likely to achieve the BP goal compared with those taking medication (P < 0.0001).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > BP
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence of achieving BP <130/80 mmHg gradually decreased with increasing age (P < 0.0001)”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > BP
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > A1C
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
- The quote only partly states this claim. 4
- It may state two separate claims as one. 11
- Probably not a substantial claim. 11
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > RESULTS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
- Rests on an assumption: Self-reported previous diagnosis of diabetes accurately identifies adults with diabetes in NHANES.
- Also stated in: § BP · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > RESULTS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this 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
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In 2007–2010, 40.1% of adults were taking a statin and achieved LDL <100 mg/dL.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESULTS > Statin use
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Almost half of Americans with diabetes did not meet each ABC goal, and 81.2% did not achieve all three goals.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this 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.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > CONCLUSIONS
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In addition, BP and lipid control substantially reduce cardiovascular disease (CVD), the major cause of death for individuals with diabetes (2).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > CONCLUSIONS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [3] American Diabetes Association, 2011, Standards of medical care in diabetes—2011, Diabetes Care source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, individuals may lack self-management skills or the resources necessary for adherence to demanding self-care regimens, often involving polypharmacy, and lifestyle change.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESEARCH DESIGN AND METHODS > Statistical analysis
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
What the sources say
- Not checked yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESEARCH DESIGN AND METHODS > Clinical measures
What the sources say
- Not checked yetcites [9] Centers for Disease Control and Prevention, National Center for Health Statistics, 2008
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Multiple clinical outcomes were assessed using standardized procedures, which allowed us to better characterize diabetes control.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“No adjustment was made for multiple comparisons.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESEARCH DESIGN AND METHODS > Statistical analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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 Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESEARCH DESIGN AND METHODS > Statistical analysis
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Rests on an assumption: The formula used to calculate LDL cholesterol from total cholesterol, HDL, and triglycerides is valid.
In the paper
“serum creatinine was calibrated across study years to reflect changes in assay methods (12).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > RESEARCH DESIGN AND METHODS > Clinical measures
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Only 7% of people with diabetes in 1999–2002 and 12% in 2003–2006 met all three ABC goals (5).”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [5] Cheung, 2009, Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006, Am J Med source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“No information was available on medication compliance to further assess individualization of treatment.”
§ The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010 > CONCLUSIONS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial 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?
In the citing paper
“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]
Citations
Cites
A New Equation to Estimate Glomerular Filtration Rate
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. (., Castro, A. F., Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-9-200905050-00006 · Cited by 25,603
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- Centers for Disease Control and Prevention, National Center for Health Statistics, 2008, National Health and Nutrition Examination Survey Laboratory Protocol: Cholesterol and Triglycerides
- Centers for Disease Control and Prevention, 2011, National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011
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Zgibor, J. C., Maloney, M. A., Malmi, M., Fabio, A., Kuo, S., Solano, F. X., Tilves, D., Tu, L., & Davidson, M. B. (2017) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.10.003 · Cited by 19
The safety of DPP-4 inhibitor and SGLT2 inhibitor combination therapies
Molina‐Vega, M., Muñoz‐Garach, A., Fernández‐García, J. C., & Tinahones, F. J. (2018) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2018.1497158 · Cited by 19
Trends in Racial and Ethnic Disparities in Diabetes-Related Complications, 1997–2017
Chiou, T. T., Tsugawa, Y., Goldman, D. P., Myerson, R. M., Kahn, M. E., & Romley, J. A. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05308-9 · Cited by 19
Metadata
- 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.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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