Risk control still a problem for diabetics

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Risk control still a problem for diabetics

Last Updated: 2004-01-21 16:18:58 -0400 (Reuters Health)

By J. Brown, MD

NEW YORK (Reuters Health) - Comparison of data from two U.S. health

surveys reveals that in the last decade little progress has been made in

improving the control of certain disease risk factors among people with

diabetes.

The only optimistic finding is that fewer patients now have total

cholesterol levels above the recommended limit.

Diabetics are at increased risk for a variety of blood vessel problems.

To reduce the odds of developing these vascular diseases, diabetics are

advised to keep tight control of their blood sugar, blood pressure, and

cholesterol levels.

From the early to late 1990s, " there was no improvement in the control

of blood (sugar) levels or blood pressure, " senior author Dr.

C. Cowie, from the National Institutes of Health in Bethesda, land,

told Reuters Health.

" I had hoped for a better public health message, since we have programs

out there stressing the importance of controlling the ABCs: HbA1C (a

blood sugar test), blood pressure, and cholesterol level, " Cowie said.

" I had expected greater improvements...but I guess it could have been a

worse message too. "

In the new study, Cowie's team compared data from the Third National

Health and Nutrition Examination Survey (NHANES III) conducted in 1988

to 1994 with that from NHANES performed in 1999 and 2000. Data from 1265

NHANES III participants and 441 NHANES 1999-2000 participants were

included in the analysis. All of the subjects were at least 20 years of

age with previously diagnosed diabetes.

The researchers' findings are published in the Journal of the American

Medical Association.

In NHANES 1999-2000, about 37 percent of subjects achieved the target

HbA1C goal of less than 7 percent, but a similar proportion had values

above the recommended 8 percent " take-action " level. Neither of these

figures were a significant change from those recorded in NHANES III.

In the 1999-2000 survey, 36 percent of subjects achieved target blood

pressures, but 40 percent of subjects had high blood pressure, the

authors note. Like sugar control, blood pressure control did not change

significantly between the two survey periods.

Control of total cholesterol levels, by contrast, did improve during the

study period. In NHANES 1999-2000, 52 percent of subjects had levels

above the recommended 200 cutoff, a significant drop from the 66 percent

identified in NHANES III.

" This may be due to a higher proportion of patients now using

cholesterol-lowering drugs, " Cowie said.

Further analysis of NHANES 1999-2000 data revealed that only 7 percent

of subjects had HbA1c values, blood pressures, and cholesterol levels at

or below the recommended limits.

Cowie said that a follow-up study is currently in the works that will

hopefully shed light on why control of vascular disease risk factors has

not improved.

SOURCE: Journal of the American Medical Association, January 21, 2004.

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