HbA1c, glycemic control worsened for US adults with diabetes from 2020 to 2023
Key takeaways:
- Diabetes prevalence remained steady in the U.S. from 2013 to 2023.
- Fewer adults with diabetes in the U.S. achieved an HbA1c of less than 7% in 2021 to 2023 compared with 2013 to 2020.
The prevalence of diabetes in the U.S. did not significantly change from 2013 to 2023, but the percentage of adults with diabetes achieving glycemic control fell after 2020, according to a research letter published in JAMA.
Researchers assessed diabetes prevalence among adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey during the 2013-2014, 2015-2016, 2017-2020 and 2021-2023 cycles. Mean HbA1c and the proportion of adults with diabetes achieving glycemic control, defined as an HbA1c of less than 7%, declined in 2021-2023 compared with prior years, especially among younger adults aged 20 to 44 years.
“Our findings are very concerning, because poor control of cardiometabolic risk factors like diabetes increases lifetime risk of having a heart attack or a stroke,” Rishi K. Wadhera, MD, MPP, MPhil, associate professor at Harvard Medical School and associate director of the Smith Center for Outcomes Research, told Healio. “We found a crisis of worsening diabetes control among young adults, which began between 2021 and 2023. These concerning changes could be related to spillover effects of the COVID-19 pandemic, including disruptions in access to health care, increases in sedentary behaviors and worsening social support and psychosocial stressors.”
The study included 24,263 adults who had HbA1c measurements available (mean age, 48.5 years; 51.4% women). Of the study group, 4,623 had diabetes as defined by an HbA1c of 6.5% or higher, a fasting plasma glucose of 126 mg/dL or greater, or a diagnosis.
Diabetes prevalence did not significantly change during the study. The percentage of adults with diabetes was 12.8% in the 2013-2014 cycle and 14.1% in the 2021-2023 cycle. Mean HbA1c was stable from 2013 to 2020 but significantly rose from 7.31% in the 2017-2020 cycle to 7.6% in 2021-2023 (P = .03). The proportion of adults with diabetes who had an HbA1c of less than 7% also fell, from 54.3% in 2017-2020 to 43.5% in 2021-2023 (P = .02).
Increases in HbA1c and decreased glycemic control rates from 2017-2020 to 2021-2023 were primarily observed among adults aged 20 to 44 years. Among that age group, mean HbA1c rose from 7.43% in 2017-2020 to 8.51% in 2021-2023 (P = .03). The percentage of younger adults with diabetes achieving glycemic control fell from 57.4% in 2017-2020 to 37.1% in 2021-2023 (P = .006). Significant changes in HbA1c and glycemic control rates were not seen among other age groups.
Wadhera said the medical community should put a greater focus on making sure younger adults are receiving proper preventive care and screening.
“We need to ensure that our younger adult patients are coming in for their annual checkups, receiving guideline-recommended screenings for cardiometabolic risk factors and being appropriately treated and monitored, so that their risk factors are well controlled,” Wadhera told Healio. “Our findings highlight that we also need public health and policy efforts focused on optimizing care and treatment for young adults with diabetes, to directly address the crisis of poor glycemic control that’s emerging in this population.”
For more information:
Rishi K. Wadhera, MD, MPP, MPhil, can be reached at rwadhera@bidmc.harvard.edu.
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