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Sharon H. Saydah, PhD; Judith Fradkin, MD; Catherine C. Cowie, PhD

JAMA. 2004;291:335-342.

Context  Control of blood glucose levels, blood pressure, and cholesterol levels is proven to reduce the risk of vascular disease among individuals with diabetes mellitus; however, the current state of control of these risk factors among individuals in the United States is uncertain.

Objectives  To examine 1999-2000 national data on control of risk factors for vascular disease among adults with previously diagnosed diabetes and to assess trends during the past decade.

Design, Setting, and Participants  Review of data from the Third National Health and Nutrition Examination Survey (NHANES III, conducted 1988-1994) and NHANES 1999-2000, cross-sectional surveys of a nationally representative sample of the noninstitutionalized civilian US population. Participants were adults aged 20 years and older with previously diagnosed diabetes who participated in both the interview and examination in either NHANES III (n = 1265) or NHANES 1999-2000 (n = 441).

Main Outcome Measures  Levels of glycosylated hemoglobin (HbA_1c), blood pressure, and total serum cholesterol in reference to target goals.

Results  Compared with NHANES III, participants with previously diagnosed diabetes in NHANES 1999-2000 were similar by age and sex, were less likely to be non-Hispanic white, were diagnosed at an earlier age, had a higher body mass index, and were more likely to use insulin in combination with oral agents. In NHANES 1999-2000, only 37.0% of participants achieved the target goal of HbA_1c level less than 7.0% and 37.2% of participants were above the recommended "take action" HbA_1c level of greater than 8.0%; these percentages did not change significantly from NHANES III (P = .11 and P = .87, respectively). Only 35.8% of participants achieved the target of systolic blood pressure (SBP) less than 130 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg, and 40.4% had hypertensive blood pressure levels (SBP 140 or DBP 90 mm Hg). These percentages did not change significantly from NHANES III (P = .10 and P = .56, respectively). Over half (51.8%) of the participants in NHANES 1999-2000 had total cholesterol levels of 200 mg/dL or greater (vs 66.1% in NHANES III; P<.001). In total, only 7.3% (95% confidence interval, 2.8%-11.9%) of adults with diabetes in NHANES 1999-2000 attained recommended goals of HbA_1c level less than 7%, blood pressure less than 130/80 mm Hg, and total cholesterol level less than 200 mg/dL (5.18 mmol/L).

Conclusion  Further public health efforts are needed to control risk factors for vascular disease among individuals with diagnosed diabetes.

Author Affiliations: US Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md (Dr Saydah); National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md (Drs Fradkin and Cowie).

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ABSTRACT | FULL TEXT  

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ABSTRACT | FULL TEXT  

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FULL TEXT  

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ABSTRACT  

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ABSTRACT  

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ABSTRACT | FULL TEXT  

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ABSTRACT | FULL TEXT  

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FULL TEXT  

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ABSTRACT  

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FULL TEXT  

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ABSTRACT | FULL TEXT  

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FULL TEXT  

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