Cited by 719Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and EducationDiabetes Management and Research

The DOI matches its Crossref record; 18 of the 19 references it cites were found in a registry or an index; none of the 12 sources its claims cite is checked for support yet.

The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010

Open access
Stark Casagrande, Sarah, Fradkin, Judith E., Saydah, Sharon H., Rust, Keith F., Cowie, Catherine C.·2013·Diabetes Care

Abstract

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.

Overview

AI snapshot

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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Integrity signals

Registry

Crossref · 10.2337/dc12-2258

Cites

18 of 18 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 12 cited sources checked · 0 supported · 0 flagged

Show all 46 claims

  • The quote only partly states this claim. 4
  • It may state two separate claims as one. 11
  • Probably not a substantial claim. 11
22 of 22
  • 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)].”
5 of 5

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Citations

Cites

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1 of the 19 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Centers for Disease Control and Prevention, National Center for Health Statistics, 2008, National Health and Nutrition Examination Survey Examination Protocol
  2. Centers for Disease Control and Prevention, National Center for Health Statistics, 2008, National Health and Nutrition Examination Survey Laboratory Protocol: Cholesterol and Triglycerides
  3. 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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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
Published
2013-07-11
Volume
36
Issue
8
Pages
2271-2279
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
OpenAlex
W2007221722
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
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

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