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Epidemiology/Health Services Research

Is Glycemic Control Improving in U.S. Adults?

  1. Thomas J. Hoerger, PHD1,
  2. Joel E. Segel, BA1,
  3. Edward W. Gregg, PHD2 and
  4. Jinan B. Saaddine, MD2
  1. 1RTI International, Research Triangle Park, North Carolina
  2. 2Centers for Disease Control and Prevention, Atlanta, Georgia
  1. Address correspondence and reprint requests to Thomas J. Hoerger, Director, RTI-UNC Center of Excellence in Health Promotion Economics, RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709. E-mail: tjh{at}rti.org
Diabetes Care 2008 Jan; 31(1): 81-86. https://doi.org/10.2337/dc07-1572
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    Figure 1—

    A1C distribution by NHANES wave.

Tables

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  • Table 1—

    Characteristics among individuals who have been told they have diabetes and who received an A1C measurement by NHANES wave

    NHANES 1999–2000NHANES 2001–2002NHANES 2003–2004
    n403448482
    Age (years)59.0 ± 0.857.4 ± 1.259.7 ± 0.8
        18–44 (%)15.6 ± 2.722.1 ± 3.413.2 ± 1.6
        45–64 (%)45.8 ± 3.344.2 ± 3.444.9 ± 2.9
        65+ (%)38.6 ± 2.133.8 ± 3.441.9 ± 3.3
    Sex (%)
        Female48.4 ± 3.749.7 ± 2.052.4 ± 1.4
        Male51.6 ± 3.750.3 ± 2.047.6 ± 1.4
    Race/ethnicity (%)
        White non-Hispanic61.2 ± 6.263.4 ± 3.970.8 ± 5.4
        Black non-Hispanic15.8 ± 3.814.4 ± 3.014.0 ± 2.9
        Hispanic17.0 ± 6.515.1 ± 4.511.3 ± 3.6
        Other5.9 ± 3.37.0 ± 2.43.8 ± 1.2
    Education (%)
        <High school43.2 ± 3.930.5 ± 2.729.8 ± 2.3
        High school25.7 ± 4.524.7 ± 2.224.3 ± 2.2
        >High school31.1 ± 4.744.8 ± 3.245.9 ± 2.7
    BMI (kg/m2)32.3 ± 0.631.5 ± 0.532.2 ± 0.7
        <30 (%)45.8 ± 4.448.7 ± 4.142.8 ± 4.0
        ≥30 (%)54.2 ± 4.451.3 ± 4.157.2 ± 4.0
    Income (%)
        <$20,00036.3 ± 4.128.8 ± 3.428.7 ± 2.8
        $20,000+63.7 ± 4.171.2 ± 3.471.3 ± 2.8
    Insurance (%)87.0 ± 2.991.3 ± 1.889.7 ± 1.5
    Duration (%)
        <5 years34.3 ± 3.637.5 ± 3.133.7 ± 2.8
        5–14 years33.1 ± 3.035.0 ± 3.039.1 ± 2.5
        15+ years32.6 ± 3.027.3 ± 2.427.0 ± 2.8
    Smoker (%)
        Current16.4 ± 2.622.6 ± 2.020.4 ± 2.4
        Former33.2 ± 3.731.4 ± 2.134.6 ± 2.4
        Never50.5 ± 4.946.0 ± 2.445.0 ± 2.9
    Diabetes treatment (%)
        Diabetes pills only53.2 ± 3.656.6 ± 2.458.9 ± 3.6
        Insulin only16.2 ± 2.216.4 ± 3.513.6 ± 2.0
        Pills and insulin10.7 ± 3.59.5 ± 1.89.2 ± 1.9
        Diet only19.9 ± 3.717.5 ± 2.718.3 ± 2.8
    • Data are means ± SEM.

  • Table 2—

    Mean A1C and the proportion of individuals with A1C <7.0% by NHANES wave

    A1C
    A1C <7%
    NHANES 1999–2000NHANES 2001–2002NHANES 2003–2004NHANES 1999–2000NHANES 2001–2002NHANES 2003–2004
    n403448482403448482
    Overall7.82 ± 0.177.47 ± 0.167.18 ± 0.11*36.9% ± 4.449.4 ± 3.6*56.8 ± 3.5*
    Age
        18–44 years8.71 ± 0.827.68 ± 0.317.22 ± 0.2429.7 ± 13.042.9 ± 9.148.5 ± 5.3
        45–64 years7.81 ± 0.197.68 ± 0.257.59 ± 0.1840.0 ± 6.647.5 ± 4.248.5 ± 5.8
        65+ years7.49 ± 0.167.04 ± 0.12*6.72 ± 0.07*36.2 ± 6.056.3 ± 4.4*68.3 ± 2.7*
    Sex
        Female7.91 ± 0.287.36 ± 0.167.04 ± 0.10*37.1 ± 5.952.3 ± 4.0*58.2 ± 4.6*
        Male7.75 ± 0.147.57 ± 0.217.33 ± 0.2336.7 ± 4.746.6 ± 4.455.2 ± 4.5*
    Race/ethnicity
        White non-Hispanic7.52 ± 0.257.23 ± 0.146.90 ± 0.11*41.5 ± 6.753.3 ± 4.263.3 ± 4.3*
        Black non-Hispanic8.26 ± 0.217.82 ± 0.227.61 ± 0.21*28.5 ± 4.044.2 ± 4.2*44.4 ± 5.0*
        Hispanic8.10 ± 0.177.71 ± 0.368.36 ± 0.3435.2 ± 5.947.1 ± 5.137.2 ± 6.2
        Other9.01 ± 0.258.40 ± 0.657.15 ± 0.18*16.9 ± 7.830.3 ± 15.040.6 ± 12.8
    Education
        <High school7.96 ± 0.137.57 ± 0.277.57 ± 0.2930.5 ± 3.951.5 ± 5.2*43.7 ± 5.5
        High school7.32 ± 0.277.47 ± 0.167.01 ± 0.1451.6 ± 7.047.2 ± 5.258.8 ± 5.4
        >High school8.05 ± 0.417.40 ± 0.227.01 ± 0.12*33.9 ± 7.449.2 ± 4.364.2 ± 4.7*
    BMI
        BMI <30 kg/m28.13 ± 0.317.48 ± 0.287.34 ± 0.15*32.8 ± 7.753.9 ± 5.0*50.6 ± 5.1
        BMI ≥30 kg/m27.62 ± 0.117.46 ± 0.137.06 ± 0.15*38.8 ± 4.945.8 ± 4.761.3 ± 4.5*
    Income
        <$20,0008.18 ± 0.317.22 ± 0.20*7.23 ± 0.19*33.7 ± 4.954.8 ± 4.3*55.4 ± 5.9*
        ≥$20,0007.66 ± 0.177.55 ± 0.197.16 ± 0.12*38.4 ± 6.447.6 ± 4.157.3 ± 3.8*
    Insurance
        Uninsured8.55 ± 0.708.44 ± 0.517.54 ± 0.3844.3 ± 9.637.8 ± 6.846.1 ± 12.2
        Insured7.70 ± 0.157.35 ± 0.157.13 ± 0.12*35.6 ± 5.050.8 ± 3.7*58.1 ± 3.8*
    Duration
        <5 years7.94 ± 0.497.09 ± 0.176.74 ± 0.20*40.7 ± 7.157.8 ± 5.0*74.2 ± 5.3*
        5–14 years7.94 ± 0.137.88 ± 0.327.49 ± 0.15*34.2 ± 4.241.3 ± 5.950.0 ± 4.5*
        15+ years7.58 ± 0.197.46 ± 0.227.26 ± 0.1535.7 ± 7.048.2 ± 5.544.6 ± 6.5
    Smoker
        Current7.99 ± 0.337.49 ± 0.317.48 ± 0.3228.9 ± 10.550.0 ± 8.050.2 ± 6.1
        Former7.47 ± 0.147.18 ± 0.267.00 ± 0.13*46.6 ± 4.055.7 ± 8.060.3 ± 5.4*
        Never8.00 ± 0.287.65 ± 0.207.17 ± 0.14*33.2 ± 5.044.6 ± 4.957.3 ± 4.8*
    Diabetes treatment
        Diabetes pills only7.80 ± 0.187.37 ± 0.177.26 ± 0.07*34.1 ± 4.950.3 ± 4.1*55.3 ± 3.8&*
        Insulin only8.70 ± 0.408.15 ± 0.317.79 ± 0.2524.2 ± 10.430.4 ± 6.733.2 ± 9.6
        Pills and insulin8.32 ± 0.208.22 ± 0.457.92 ± 0.1613.7 ± 6.926.1 ± 12.236.3 ± 7.0*
        Diet only7.04 ± 0.316.73 ± 0.436.07 ± 0.18*62.6 ± 9.877.2 ± 7.189.7 ± 4.8*
    • Data are means ± SEM.

    • ↵* Significantly different from NHANES 1999–2000 at P < 0.05.

  • Table 3—

    Multivariate regression results: effects of demographic factors and NHANES wave on A1C

    No treatment variables included
    Treatment variables included
    Coefficient (SE)95% CICoefficient (SE)95% CI
    Age−0.024 (0.008)*−0.039 to −0.008−0.022 (0.007)*−0.036 to −0.008
    Black non-Hispanic0.553 (0.188)*0.175 to 0.9310.495 (0.171)*0.152 to 0.839
    Hispanic0.424 (0.267)−0.114 to 0.9630.500 (0.264)−0.032 to 1.032
    Other0.660 (0.284)*0.087 to 1.2320.575 (0.263)*0.044 to 1.105
    Female−0.168 (0.150)−0.471 to 0.135−0.156 (0.137)−0.431 to 0.119
    <High school0.263 (0.213)−0.165 to 0.6920.208 (0.194)−0.182 to 0.599
    High school0.041 (0.188)−0.338 to 0.4210.049 (0.169)−0.292 to 0.39
    BMI−0.020 (0.013)−0.046 to 0.005−0.026 (0.011)*−0.049 to −0.003
    Insured−0.519 (0.343)−1.21 to 0.171−0.624 (0.329)−1.286 to 0.038
    Income <$20K0.075 (0.158)−0.244 to 0.3940.079 (0.147)−0.217 to 0.375
    Duration 5–14 years0.626 (0.205)*0.213 to 1.040.428 (0.205)*0.015 to 0.84
    Duration 15+ years0.472 (0.216)*0.036 to 0.9080.099 (0.229)−0.363 to 0.561
    Diabetes pills only—0.949 (0.182)*0.582 to 1.317
    Insulin only—1.658 (0.237)*1.18 to 2.137
    Diabetes pills and insulin—1.564 (0.263)*1.033 to 2.095
    NHANES 2001–2002−0.308 (0.234)−0.78 to 0.164−0.317 (0.194)−0.708 to 0.073
    NHANES 2003–2004−0.511 (0.222)*−0.959 to −0.063−0.500 (0.164)*−0.830 to −0.169
    Constant9.662 (1.042)*7.563 to 11.7619.123 (0.902)*7.305 to 10.941
    n1,1321,129
    R20.1180.196
    • ↵* Significant at P < 0.05.

  • Table 4—

    Multivariate logistic results: ORs and predictive margins by NHANES wave

    No treatment variables included
    Treatment variables included
    ORsPredictive margin (%)ORsPredictive margin (%)
    A1C <7.0%
        1999–20001.0037.0 (4.6)1.0036.8 (3.6)
        2001–20021.75 (0.45)*49.7 (3.2)1.91 (0.43)*50.0 (3.1)
        2003–20042.27 (0.58)*55.7 (3.4)2.52 (0.57)*55.8 (3.4)
    A1C <8.0%
        1999–20001.0061.9 (3.8)1.0062.2 (3.2)
        2001–20021.60 (0.40)71.4 (2.9)1.61 (0.37)*71.3 (2.9)
        2003–20042.00 (0.46)*75.4 (2.3)2.04 (0.40)*75.3 (2.1)
    A1C <9.0%
        1999–20001.0081.3 (3.4)1.0081.4 (3.0)
        2001–20021.11 (0.37)82.6 (2.7)1.09 (0.35)82.5 (2.8)
        2003–20041.61 (0.48)86.9 (1.5)1.64 (0.44)87.0 (1.5)
    • Data are ORs (SE) or predictive margin (SE). Results control for age, sex, race/ethnicity, education, BMI, insurance, income, and duration of diabetes. Treatment variables include use of diabetes pills only, insulin only, and insulin and diabetes pills; the treatment variable omitted is diet only.

    • ↵* ORs are significantly different from 1999–2000 at P < 0.05.

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Is Glycemic Control Improving in U.S. Adults?
Thomas J. Hoerger, Joel E. Segel, Edward W. Gregg, Jinan B. Saaddine
Diabetes Care Jan 2008, 31 (1) 81-86; DOI: 10.2337/dc07-1572

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Is Glycemic Control Improving in U.S. Adults?
Thomas J. Hoerger, Joel E. Segel, Edward W. Gregg, Jinan B. Saaddine
Diabetes Care Jan 2008, 31 (1) 81-86; DOI: 10.2337/dc07-1572
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