Diabetes Self-Care Improves Slowly, U.S. Report Finds

But nearly half of patients aren't meeting goals for blood sugar, blood pressure and cholesterol

Wednesday, April 24, 2013

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WEDNESDAY, April 24 (HealthDay News) -- More Americans are meeting diabetes care goals, but nearly half still aren't achieving major targets for controlling blood sugar, blood pressure and cholesterol, government health officials say.
Just 14 percent of people with diabetes hit all the recommended health targets during the first decade of the 21st century, according to the new report from the U.S. Centers for Disease Control and Prevention and the U.S. National Institutes of Health.
Researchers found that between 1999 and 2010, the number of people with diabetes who achieved their blood sugar goals improved by about 8 percent. That same time period saw a nearly 12 percent improvement in the number of people meeting their blood pressure goals.
And 21 percent more people lowered their LDL cholesterol (the bad type) to less than 100 milligrams per deciliter during the study time period.
Tobacco use was one area where the numbers didn't move.
"The overarching theme is slow and steady improvement. Just a 1 percent improvement in hemoglobin A1C [a long-term measure of blood sugar levels] in 19 million people with diabetes is tremendous," said report author Dr. Mohammed Ali, an assistant professor of global health and epidemiology at the Rollins School of Public Health at Emory University and a consultant in the CDC's division of diabetes translation in Atlanta.
"There are still huge gaps," Ali said. "We have a good report card, but we have a long way to go in certain aspects, like blood pressure control and tobacco use. One in five people with diabetes still use some form of tobacco."
Almost 19 million U.S. adults have diabetes, according to background information in the study. "Probably 95 percent or higher have type 2 diabetes," said Ali. Type 2 diabetes is considered preventable. Untreated or poorly treated diabetes can lead to serious complications, including vision problems and kidney disease.
According to the report, the primary goals for diabetes care include:

Hemoglobin A1C of 7 percent or less
Blood pressure of less than 130/80 mm Hg
LDL cholesterol levels below 100 milligrams per deciliter
No tobacco use

The current report, published in the April 25 issue of the New England Journal of Medicine, includes data from more than 100,000 adults who reported a diabetes diagnosis by a health care professional. The data was from two nationally representative studies, but neither study broke its information down by diabetes type.
"We've always been so focused on [blood sugar], but the key for anybody with diabetes is comprehensive control of risk factors. So don't forget your blood pressure. Don't forget your cholesterol. Don't smoke. These are the things, along with [blood sugar], that are really going to improve your quality of life," said Ali.
Between 33 percent and 49 percent of people with diabetes were not meeting their targets for blood sugar, blood pressure and cholesterol control, the report found.
Dr. Graham McMahon, co-author of an accompanying journal editorial and a diabetes specialist at Brigham and Women's Hospital in Boston, finds the figures disappointing.
"I think these results show slower than anticipated progress in meeting diabetes goals," he said.
McMahon thinks changes are needed in the way diabetes is managed and reimbursed.
"Clinicians should be given credits for improvements toward a goal," he explained. "You want to have a combination of factors that acknowledge the difficulty and complexity of engaging patients in self-care."
The best way for diabetes care providers to promote patients' self-care is to partner with them, he said. This includes exploring and dismantling the obstacles the patient experiences, noted McMahon.
"Diabetes can be all-consuming for a patient. It changes the way you interact with family and friends, and in how you view yourself, whether you consider yourself well or not well," McMahon said. Type 2 diabetes "also affects feelings of self-worth and fault because the community often blames people for having this problem."
McMahon said he'd like to see care move toward a more patient-centered environment that can help patients identify helpful strategies for improving their health. This could be accomplished with health care teams -- including nurse educators, primary care doctors, endocrinologists, podiatrists, ophthalmologists and nutritionists -- that would address the whole patient, said McMahon.

SOURCES: Mohammed Ali, M.B.Ch.B., assistant professor, global health and epidemiology, Rollins School of Public Health at Emory University, and consultant, division of diabetes translation, U.S. Centers for Disease Control and Prevention, Atlanta; Graham McMahon, M.D., M.M.Sc., associate professor, medicine, Harvard Medical School, and diabetes specialist, Brigham and Women's Hospital, Boston; April 25, 2013, New England Journal of Medicine

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