Prevalence of obesity increasing among US adults with diabetes
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The proportion of adults with diabetes and obesity in the U.S. increased from 1999 to 2020, though more adults achieved blood pressure and lipid control during that period, according to a study published in Obesity.
In an analysis of data from the National Health and Nutrition Examination Survey, the prevalence of obesity class I, class II and class III have all increased among U.S. adults with diabetes since 1999. Additionally, fewer adults with diabetes achieved glycemic control with an HbA1c of less than 7% in 2015-2020 compared with 2007-2010. Data did not distinguish between type 1 and type 2 diabetes.
“This is a call to action,” Gang Hu, MD, PhD, associate professor at Pennington Biomedical Research Center, and Donna H. Ryan, MD, professor emerita at Pennington Biomedical Research Center, told Healio. “We need to be weight-centric in our management of persons with diabetes because we can never achieve optimal risk factor control, prevention of complications and improved quality of life if we don’t address weight management.”
Researchers collected NHANES data from every cycle beginning in 1999-2000 and ending in 2017-2020. The survey years were pooled into four 4-year intervals and one 6-year interval: 1999-2002, 2003-2006, 2007-2010, 2011-2014 and 2015-2020.The study examined 6,605 adults aged 20 years and older with diabetes. BMI, waist circumference, HbA1c, BP, cholesterol and triglycerides were measured. All participants completed self-administered questionnaires. Medication usage was self-reported and broken down into three categories: glucose-lowering, BP-lowering and lipid-lowering.
Obesity prevalence increasing over time
The cohort had a mean increase in BMI from 31 kg/m2 in 1999-2002 to 32.6 kg/m2 in 2015-2020. The percentage of adults with obesity class I (22.5% to 26.5%), obesity class II (14.1% to 16.6%) and obesity class III (10.3% to 14.8%) increased from the 1999-2002 period to the 2015-2020 period, whereas the proportion of adults with normal weight (17.1% to 12.7%) and overweight (35.9% to 29.2%) decreased during that same time. The prevalence of adults with central obesity, defined as a waist circumference of at least 102 cm for men and 88 cm for women, also increased from 72.9% in 1999-2002 to 79.1% in 2015-2020.
Mean HbA1c declined in the cohort from 1999-2002 to 2007-2010 before increasing for the remainder of the study period. However, for adults with normal weight, HbA1c decreased across the entire study from 7.85% in 1999-2002 to 7.26% in 2015-2020. Systolic BP was stable throughout the study for adults with normal weight, while those with overweight and obesity had a decrease from 1999-2002 to 2015-2020. Non-HDL cholesterol decreased consistently across all BMI categories.
Less than 20% of adults achieving ADA targets
The proportion of adults achieving an HbA1c of less than 7% increased from 42.5% in 1999-2002 to 51.8% in 2007-2010 before decreasing to 48% in 2015-2020. The percentage of participants achieving BP of less than 140/90 mm Hg increased from 53.2% in 1999-2002 to 69.3% in 2011-2014 before decreasing to 65.9% in 2015-2020. The proportion of participants who achieved non-HDL cholesterol of less than 130 mg/dL increased across the entire study period for all BMI categories. The percentage of adults who achieved all three of the American Diabetes Association’s recommendations for glycemic, BP and non-HDL cholesterol increased from 8.3% in 1999-2002 to 21.2% in 2011-2014 before declining to 18.5% in 2015-2020.
“We have many effective medications for blood pressure and lipid management, we should be getting better and better at meeting these goals,” Hu and Ryan said. “We were getting better at meeting these BP and lipid targets until the 2015-2020 survey, when the results got worse. What was most surprising was the HbA1c target results. It was surprising that, despite great advances in pharmacotherapy for glycemia, we weren’t doing better than we observed. We have great medications for controlling these risk factors and we have fallen to less than one in five adults with diabetes meeting all the targets.”
Use of lipid-lowering drugs increasing
Use of glucose-lowering medications increased from 84.7% in 1999-2002 to a peak of 88.2% in 2007-2010 before decreasing to 82.7% in 2015-2020. BP-lowering medication use increased from 51.8% in 1999-2002 to a peak of 66.1% in 2007-2010 before dropping slightly to 62.5% in 2015-2020. The percentage of adults using lipid-lowering medications nearly doubled from 27.8% in 1999-2002 to 53.9% in 2015-2020.
Hu and Ryan said one of the keys to reducing the prevalence of obesity in the U.S. is for adults with diabetes to get better support in their weight-loss efforts from health care providers, especially primary care providers.
“We don’t have proven approaches in routine practice, although some commercial and community-based lifestyle programs have shown successful outcomes,” Hu and Ryan said. “The advent of newer medications for management of glycemia with robust weight-loss effects and newer medications for weight management may be helpful to clinicians in addressing weight as a pathway to better diabetes management. We need to give our health care providers tools for helping patients manage weight.”
For more information:
Gang Hu, MD, PhD, can be reached at gang.hu@pbrc.edu.
Donna H. Ryan, MD, can be reached at donna.ryan@pbrc.edu.
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