Undertreatment of cardiovascular risk factors among persons with diabetes in the United States

ObjectiveWe examined the extent of control of cardiovascular risk factors and distance from goal for those with uncontrolled levels in a recent sample of U.S. adults with diabetes.MethodsIn the cross-sectional National Health and Nutrition Examination Survey 2001–2002, 532 (projected to 15.2 million) or 7.3% of adults aged ≥18 years had diabetes. Use of antihypertensive, antidiabetic and antidyslipidemic medications was examined. We determined the proportion of subjects not at goal for blood pressure (BP), lipids and glycosylated hemoglobin (A1C) and examined the distance from goal for those not under control.ResultsOverall, 50.2% of subjects with diabetes were not at goal for A1C, 64.6% for low density lipoprotein-cholesterol (LDL-C), 52.3% for high density lipoprotein-cholesterol (HDL-C), 48.6% for triglycerides and 53.0% BP. Only 5.3% of men and 12.7% of women with diabetes were simultaneously at goal for A1C, LDL-C and BP. Even among those on treatment, most were not at goal for these parameters. Women were more likely to have LDL-C and HDL-C not at goal than men. Non-Hispanic Blacks were more often not at goal for BP and LDL-C. Mean distances from targets were 36 mg/dL for LDL-C, 18 mmHg for systolic BP, 6 mmHg for diastolic BP and 2.0% for A1C in patients not at goal.ConclusionsMany U.S. adults with diabetes have sub-optimal control of cardiovascular risk factors and remain far from target goals for BP, lipids and A1C, even if on treatment.