Only 1 in 3 US Adults With Diabetes Receive ADA-Recommended Care

Miriam E. Tucker

May 04, 2021

In 2017-2018, only one in three US adults with diabetes received five basic elements of care recommended by the American Diabetes Association (ADA), new research indicates.

The proportions of patients who visited a physician for diabetes care and received A1c testing, foot and eye exams, and cholesterol testing increased from 2005 to 2018. However, this increase was primarily among those aged 65 and older, and therefore eligible for Medicare.

"Our study suggests that providing affordable health care coverage can help ensure people with diabetes get recommended care. We also found that patients who were not receiving recommended care were more likely to be younger, newly diagnosed with diabetes, and not on diabetes medication. Clinicians can pay more attention to these patient populations to improve recommended care delivery and prevent diabetes-related complications," lead author Jung-Im Shin, MD, told Medscape Medical News.

The data pre-date the COVID-19 pandemic, which has also had major effects on delivery of diabetes care, added Shin, of Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

"Routine visits to the doctor and important screenings for retinopathy or foot examination have been postponed. People with diabetes have had to reschedule or cancel nonurgent visits, some have lost...insurance following unemployment, and many have avoided health care facilities out of fear. We are only just beginning to understand the consequences of the pandemic on the health of people with diabetes," Shin notes.

Overall Improvements Seen Only Among Those Aged 65 and Older

The data, from 4069 adults aged 20 years and older from the 2005-2018 National Health and Nutrition and Examination Survey (NHANES), were published online April 16 in Diabetes Care.

Shin and colleagues defined receipt of diabetes care as meeting all of the following five criteria in the past 12 months, based on the ADA Standards of Care and NHANES data availability: seeing a primary doctor for diabetes care; receiving A1c testing; receiving a foot examination; receiving an eye examination; and receiving cholesterol testing.

Over the entire 13-year period, 29.2% of respondents reported having received all five components.

That proportion increased significantly over time, from 25.0% in 2005-2006 to 34.1% in 2017-2018 (Ptrend = .004). However, among the individual components, only receiving A1c testing increased significantly over time, from 64.4% to 85.3%, in all age groups (Ptrend < .001).

Moreover, when stratified by age, receipt of all five components only increased significantly among participants aged 65 and older, from 29.3% in 2005-2006 to 44.2% in 2017-2018 (Ptrend = .001).

The proportion remained unchanged among those aged 40-64 (25.2% to 25.8%; Ptrend =  .457) and showed a nonsignificant increase in those aged 20-39 (9.9% to 26.0%; Ptrend = .401).

In adjusted analyses, older age, higher income and education, health insurance, longer duration of diabetes, use of diabetes medications, and hypercholesterolemia were significantly associated with receipt of ADA guideline-recommended diabetes care.

Factors not found to be associated with care receipt included sex, race/ethnicity, body mass index, smoking status, A1c, hypertension, cardiovascular disease, chronic kidney disease, and depressive symptoms.

Participants who received ADA guideline-recommended care were significantly more likely to achieve A1c below 7.5% (adjusted odds ratio, 1.52), blood pressure less than 140/90 mmHg (1.47), and LDL-cholesterol below 100 mg/dL (1.47), and to receive cholesterol-lowering medication (1.79).

Shin told Medscape Medical News that it will be "important to study the impact of COVID-19 on diabetes care when new data are available."

The project was supported by a research grant from Merck to the Johns Hopkins Bloomberg School of Public Health. Shin has reported receiving a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. Two coauthors are Merck employees.  

Diabetes Care. Published online April 16, 2021. Abstract

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.

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