Since 2010, there has been a decrease in blood pressure (BP) and glycemic control in patients with diabetes, which is a significant shift from the progress made in previous decades. Guidelines recommend patient-centered team care for decision making and goal setting. We conducted this study to estimate the proportion of patients with diabetes mellitus who recalled discussions on individual treatment targets with their health care provider.
We used data from adults aged ≥20 years with diagnosed diabetes mellitus in 4 cycles of the National Health and Nutrition Examination Survey: 2011 to 2012, 2013 to 2014, 2015 to 2016, and 2017 to March 2020 ( Supplementary Figure 1 ). The primary objective of our study was to assess the proportion of respondents who recalled any glycated hemoglobin (HbA1c) target, BP target, or low-density lipoprotein-cholesterol (LDL-C) target individually across survey cycles. The secondary objective was to evaluate factors independently associated with recalling any HbA1c target in a multivariable logistic regression model consisting of age, gender, race, education, insurance, family income-to-poverty ratio, actual HbA1c, duration of diabetes mellitus, and insulin treatment. These risk factors were chosen a priori based on previous studies. , Chi-square test was used to compare the group proportions between surveys. Proportions were weighted according to the survey weights provided with each survey ( Supplementary Methods ). Proportions were age-standardized using the 2000 Census Population.
Across all surveys, mean age was approximately 60 years, most respondents were non-Hispanic Whites, and women constituted approximately 50% of the population ( Supplementary Table 1 ). Most respondents (99.4%) had ≥1 doctor visit in the preceding year. The mean duration of diabetes mellitus was around 10 years. Overall, >80% of respondents in each survey cycle reported a provider-specified glycemic target ( Figure 1 , Table 1) . There was no change in this proportion over the 4 surveys (p >0.05). There was no significant difference in recall proportions across the racial subgroups.
| 2011–2012 | 2013–2014 | 2015–2016 | 2017–2020 | |
|---|---|---|---|---|
| Overall | 342 | 426 | 524 | 1,056 |
| Any HbA1c target | 83.8 (74.6, 90.1) | 80.1 (66.1, 89.3) | 84.9 (75.0, 91.4) | 85.2 (77.4, 90.6) |
| Target HbA1c <7.0% | 79.2 (70.6, 85.7) | 70.7 (59.9, 79.5) | 73.7 (63.3, 82.0) | 73.0 (64.7, 80.0) |
| Target HbA1c <8.0% | 82.7 (73.2, 89.3) | 77.9 (63.3, 87.8) | 81.0 (72.5, 87.3) | 84.1 (76.1, 89.9) |
| Any BP target * | 51.2 (39.0, 63.2) | 41.0 (29.6, 53.5) | 60.4 (55.3, 65.3) | 60.8 (53.5, 67.7) |
| Target BP <130/80 mm Hg | 10.0 (6.5, 15.0) | 8.7 (6.1, 12.4) | 12.8 (7.4, 21.3) | 8.7 (6.3, 11.7) |
| Target BP <140/90 mm Hg | 43.0 (31.8, 54.9) | 29.9 (22.2, 38.9) | 48.0 (40.8, 55.3) | 47.4 (37.7, 57.3) |
| Any LDL-C target | 40.5 (22.7, 61.2) | 21.2 (13.1, 32.3) | 23.8 (17.1, 32.0) | 28.9 (19.1, 41.1) |
| Target LDL-C <100 mg/dL | 20.4 (9.7, 37.9) | 6.8 (4.1, 11.1) | 8.6 (5.6, 13.0) | 7.3 (4.6, 11.3) |
| Men | 181 (52.9) | 203 (47.7) | 283 (54.0) | 573 (54.3) |
| Any HbA1c target | 82.6 (66.6, 91.8) | 92.4 (88.7, 95.0) | 88.4 (78.6, 94.1) | 90.0 (82.5, 94.6) |
| Target HbA1c <7.0% | 77.1 (65.2, 85.8) | 73.4 (55.6, 85.9) | 73.7 (59.5, 84.2) | 77.1 (63.4, 87.2) |
| Target HbA1c <8.0% | 82.4 (66.5, 91.7) | 88.0 (80.0, 93.0) | 84.6 (76.7, 91.0) | 89.0 (81.6, 93.6) |
| Any BP target * | 57.1 (43.5, 69.6) | 48.0 (28.8, 67.8) | 57.9 (50.8, 64.8) | 69.5 (53.7, 81.7) |
| Target BP <130/80 mm Hg | 9.8 (6.3, 14.9) | 6.5 (3.4, 12.1) | 6.9 (3.0, 15.2) | 9.7 (5.8, 15.8) |
| Target BP <140/90 mm Hg | 46.8 (33.5, 60.6) | 30.1 (18.1, 45.6) | 42.4 (31.3, 54.4) | 57.7 (40.6, 73.1) |
| Any LDL-C target | 55.9 (38.6, 71.9) | 35.3 (21.8, 51.5) | 21.2 (13.3, 32.1) | 41.5 (28.4, 56.0) |
| Target LDL-C <100 mg/dL | 32.9 (23.2, 44.3) | 5.4 (8.8, 10.2) | 9.6 (6.1, 14.9) | 10.5 (5.7, 18.5) |
| Women | 161 (47.1) | 223 (52.3) | 241 (46.0) | 483 (45.7) |
| Any HbA1c target | 85.3 (74.5, 92.0) | 68.7 (63.0, 73.9) | 80.7 (66.0, 90.1) | 82.8 (73.1, 89.5) |
| Target HbA1c <7.0% | 81.9 (72.0, 88.8) | 67.5 (61.4, 73.1) | 72.3 (60.6, 81.6) | 70.8 (60.4, 79.4) |
| Target HbA1c <8.0% | 83.2 (72.5, 90.3) | 67.6 (61.5, 73.2) | 76.8 (65.4, 85.2) | 81.7 (72.0, 88.6) |
| Any BP target * | 44.3 (31.3, 58.2) | 36.1 (27.8, 45.4) | 63.2 (55.3, 70.4) | 54.1 (44.7, 63.3) |
| Target BP <130/80 mm Hg | 9.9 (5.6, 17.0) | 10.7 (6.8, 16.6) | 19.7 (10.3, 34.5) | 7.5 (4.4, 12.5) |
| Target BP <140/90 mm Hg | 38.1 (27.2, 50.5) | 29.5 (20.7, 40.1) | 52.3 (42.7, 61.7) | 39.0 (26.9, 52.6) |
| Any LDL-C target | 22.4 (14.7, 32.6) | 17.3 (11.2, 25.7) | 22.3 (14.4, 32.9) | 21.3 (11.2, 36.6) |
| Target LDL-C <100 mg/dL | 4.6 (1.7, 12.1) | 8.2 (4.1, 15.7) | 6.6 (2.6, 15.8) | 4.4 (2.0, 9.6) |
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