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Patients with diabetes have poor control of risk factors for vascular disease

The JAMA Network Journals

Despite recommendations on the importance of controlling risk factors such as blood pressure, glucose levels and cholesterol levels for preventing vascular disease, only seven percent of patients with diabetes control these factors as needed, according to a study in the January 21 issue of The Journal of the American Medical Association (JAMA).

Individuals with diagnosed diabetes are at an increased risk for vascular disease (involving the blood vessels and circulation), including microvascular complications (e.g., retinopathy, neuropathy, and nephropathy) and macrovascular complications (e.g., coronary heart disease and stroke), and lower extremity amputations, according to information in the article. Compelling evidence from well-designed, randomized clinical trials demonstrates that control of blood glucose levels, blood pressure, and cholesterol levels can delay or prevent the microvascular and macrovascular complications of diabetes.

Sharon H. Saydah, Ph.D., of the U.S. Centers for Disease Control and Prevention, Hyattsville, Md., and colleagues examined trends in control of risk factors for vascular disease among adults with diagnosed diabetes in the United States over nearly a decade. The researchers used data from two national health surveys: the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988-1994 and the NHANES 1999-2000.

The researchers compared levels of glycosylated hemoglobin (HbA1c, a measure of how well blood glucose levels are controlled), blood pressure, and total serum cholesterol among adults aged 20 years and older with previously diagnosed diabetes who participated in both the interview and examination in either NHANES III (n=1,265) or NHANES 1999-2000 (n=441).

The researchers found that in NHANES 1999-2000, only 37.0 percent of participants achieved the target goal of HbA1c level less than 7.0 percent and 37.2 percent of participants were above the recommended "take action" HbA1c level of greater than 8.0 percent; these percentages did not change significantly from NHANES III. "Only 35.8 percent of participants achieved the target of systolic blood pressure (SBP) less than 130 mm Hg and diastolic (DBP) less than 80 mm Hg, and 40.4 percent had hypertensive blood pressure levels (SBP 140 or greater or DBP 90 mm Hg or greater). These percentages did not change significantly from NHANES III. Over half (51.8 percent) of the participants in NHANES 1999-2000 had total cholesterol levels of 200 mg/dL or greater (vs. 66.1 percent in NHANES III). In total, only 7.3 percent of adults with diabetes in NHANES 1999-2000 attained recommended goals of HbA1c level less than 7 percent, blood pressure less than 130/80 mm Hg, and total cholesterol level less than 200 mg/dL," the authors write.

"... further measures are needed to reduce the large proportion of adults with diagnosed diabetes in the United States who continue to have high levels of blood glucose, blood pressure, and total cholesterol. Ongoing monitoring and measurement of the quality of care, empowering clinicians with medical decision-support tools and patients with information to improve the quality of care they receive, and building incentives for providing comprehensive care into the health care delivery system are essential to translating into practice the therapies that have been proven effective in reducing the risk of vascular disease in individuals with diabetes," the authors conclude.


(JAMA. 2004;291:335-342. Available post-embargo at

Editor's Note: The National Institute of Diabetes and Digestive and Kidney Diseases funded portions of the data collected in the NHANES III and NHANES 1999-2000. Dr. Saydah was an employee of Social and Scientific Systems Inc. during the completion of this work, under a contract from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

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