Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Diabetes Care. 2021 Jun;44(6):1300-1308. doi: 10.2337/dc20-2541. Epub 2021 Apr 16.
To characterize national trends and characteristics of adults with diabetes receiving American Diabetes Association (ADA) guideline-recommended care.
We performed serial cross-sectional analyses of 4,069 adults aged ≥20 years with diabetes who participated in the 2005-2018 National Health and Nutrition Examination Survey (NHANES).
Overall, the proportion of U.S. adults with diabetes receiving ADA guideline-recommended care meeting all five criteria by self-report in the past year (having a primary doctor for diabetes and one or more visits for this doctor, HbA testing, an eye examination, a foot examination, and cholesterol testing) increased from 25.0% in 2005-2006 to 34.1% in 2017-2018 (-trend 0.004). For participants with age ≥65 years, it increased from 29.3% in 2005-2006 to 44.2% in 2017-2018 (-trend 0.001), whereas for participants with age 40-64 and 20-39 years, it did not change significantly during the same time period: 25.2% to 25.8% (-trend 0.457) and 9.9% to 26.0% (-trend 0.401), respectively. Those who were not receiving ADA guideline-recommended care were more likely to be younger, of lower socioeconomic status, uninsured, newly diagnosed with diabetes, not on diabetes medication, and free of hypercholesterolemia.
Receipt of ADA guideline-recommended care increased only among adults with diabetes aged ≥65 years in the past decade. In 2017-2018, only one of three U.S. adults with diabetes reported receiving ADA guideline-recommended care, with even a lower receipt of care among those <65 years of age. Efforts are needed to improve health care delivery and equity in diabetes care. Insurance status is an important modifiable determinant of receiving ADA guideline-recommended care.
描述接受美国糖尿病协会（ADA）指南推荐的护理的成年糖尿病患者的国家趋势和特征。
我们对参加 2005-2018 年全国健康和营养调查（NHANES）的≥20 岁患有糖尿病的 4069 名成年人进行了连续横断面分析。
总体而言，自我报告过去一年接受 ADA 指南推荐的护理并符合所有五项标准的美国成年人的比例（有糖尿病主治医生且有一次或多次就诊、HbA 检测、眼部检查、足部检查和胆固醇检测）从 2005-2006 年的 25.0%增加到 2017-2018 年的 34.1%（趋势 0.004）。对于≥65 岁的参与者，从 2005-2006 年的 29.3%增加到 2017-2018 年的 44.2%（趋势 0.001），而对于 40-64 岁和 20-39 岁的参与者，在同一时期内没有明显变化：25.2%至 25.8%（趋势 0.457）和 9.9%至 26.0%（趋势 0.401）。未接受 ADA 指南推荐护理的人更年轻、社会经济地位较低、没有保险、新诊断为糖尿病、未服用糖尿病药物且无高胆固醇血症。
在过去十年中，仅≥65 岁的成年糖尿病患者接受 ADA 指南推荐的护理的比例有所增加。2017-2018 年，三分之一的美国成年糖尿病患者报告接受 ADA 指南推荐的护理，而年龄<65 岁的患者接受护理的比例更低。需要努力改善糖尿病护理的医疗服务提供和公平性。保险状况是接受 ADA 指南推荐护理的重要可改变决定因素。
