美国成年人糖尿病管理趋势：1999 - 2016年
Trends in Diabetes Management Among US Adults: 1999-2016.
作者信息
Fang Michael
机构信息
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, 2024 E Monument St, Baltimore, MD, 21205, USA.
出版信息
J Gen Intern Med. 2020 May;35(5):1427-1434. doi: 10.1007/s11606-019-05587-2. Epub 2020 Jan 2.
BACKGROUND
Updating national trends in diabetes management is important for identifying areas of progress and remaining gaps in diabetes care.
OBJECTIVE
Evaluate trends in diabetes management.
DESIGN
Three nationally representative, serial cross-sectional surveys (National Health and Nutrition Examination Survey [n = 5800], National Health Interview Survey [n = 48,519], and Behavioral Risk Factor Surveillance System [n = 741,497]) were used to estimate trends in diabetes management from 1999 to 2016.
PARTICIPANTS
Non-pregnant US adults (aged ≥ 18 years) diagnosed with diabetes.
MAIN MEASURES
American Diabetes Association's general recommendations for glycemic and cardiovascular risk factor control, medication usage, physical activity, preventive practices, and dietary intake.
KEY RESULTS
From 1999 to 2016, the proportion of US adults with diabetes who attained glycemic control (HbA1c < 7.0%) followed a quadratic trend (49.6% in 1999-2004 to 58.6% in 2005-2010 to 55.8% in 2011-2016, P < 0.05 for trend). Control of blood pressure (< 140/90 mmHg) and lipids (LDL cholesterol < 100 mg/dl) increased by 6.6 and 18.7 percentage points, respectively (P < 0.05 for trends). The proportion that attained glycemic, blood pressure, and lipid control followed a quadratic trend (13.3% in 1999-2004 to 24.8% in 2005-2010 to 20.2% in 2011-2016, P < 0.05 for trend). Use of antidiabetic, antihypertensive, and statin medication among those who were eligible rose by 8.6, 5.0, and 24.0 percentage points, respectively (P < 0.05 for trends). Aerobic inactivity declined 7.1 percentage points, while adherence to aerobic activity (≥ 150 min/week) and resistance training (≥ 2 times/week) recommendations grew 3.4 and 3.2 percentage points, respectively (P < 0.05 for trends). Engagement in preventive practices (e.g., receipt of vaccinations) consistently increased for 6 out of 8 outcomes. However, the adherence to saturated fat (< 10% of total daily calories) and sodium (< 2300 mg/day) recommendations fell by 6.5 and 5.2 percentage points (P < 0.05 for trends).
CONCLUSIONS
Despite notable improvements, declines in glycemic control and adherence to dietary recommendations may be growing challenges in diabetes care.
背景
更新全国糖尿病管理趋势对于确定糖尿病护理方面取得进展的领域以及仍然存在的差距非常重要。
目的
评估糖尿病管理趋势。
设计
利用三项具有全国代表性的系列横断面调查（国家健康与营养检查调查[n = 5800]、国家健康访谈调查[n = 48519]以及行为危险因素监测系统[n = 741497]）来估计1999年至2016年期间糖尿病管理的趋势。
参与者
确诊患有糖尿病的非妊娠美国成年人（年龄≥18岁）。
主要测量指标
美国糖尿病协会关于血糖和心血管危险因素控制、药物使用、身体活动、预防措施以及饮食摄入的一般建议。
关键结果
从1999年到2016年，血糖得到控制（糖化血红蛋白<7.0%）的美国糖尿病成年人比例呈二次趋势（1999 - 2004年为49.6%，2005 - 2010年为58.6%，2011 - 2016年为55.8%，趋势P<0.05）。血压（<140/90 mmHg）和血脂（低密度脂蛋白胆固醇<100 mg/dl）的控制分别提高了6.6和18.7个百分点（趋势P<0.05）。实现血糖、血压和血脂控制的比例呈二次趋势（1999 - 2004年为13.3%，2005 - 2010年为24.8%，2011 - 年为20.2%，趋势P<0.05）。符合条件者中抗糖尿病药、抗高血压药和他汀类药物的使用分别增加了8.6、5.0和24.0个百分点（趋势P<0.05）。缺乏有氧运动减少了7.1个百分点，而坚持有氧运动（≥150分钟/周）和抗阻训练（≥2次/周）建议的比例分别增加了3.4和3.2个百分点（趋势P<0.05）。8项结果中有6项的预防措施参与率（如接种疫苗）持续上升。然而，对饱和脂肪（<每日总热量的10%）和钠（<2300毫克/天）建议的依从性分别下降了6.5和5.2个百分点（趋势P<0.05）。
结论
尽管有显著改善，但血糖控制的下降和对饮食建议的依从性可能成为糖尿病护理中日益严峻的挑战。
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