A recent study published in JAMA has highlighted a troubling trend in the United States: while the overall prevalence of diabetes remained stable from 2013 to 2023, the glycemic control among patients with diabetes has worsened over the past decade. Researchers suggest that factors stemming from the COVID-19 pandemic, such as increased sedentary behavior and heightened mental health challenges, may be key contributors to this decline.
Despite diabetes affecting an estimated 38.4 million adults in the U.S. and contributing to 103,249 deaths in 2021, the overall incidence of the condition showed little change between 2013 and 2023. However, new data has raised concerns about the management of diabetes, underscoring the urgent need for policy reforms and public health initiatives to address the worsening trends in disease control.
The research, which analyzed data from the National Health and Nutrition Examination Survey (NHANES), examined the health trends of American adults between 2013 and 2023. The survey, conducted through home interviews and mobile examination centers, is nationally representative and offers a snapshot of the nation’s health.
For the study, participants aged 20 and above with available HbA1c data were included. Diabetes was defined by an HbA1c level of 6.5% or greater, a fasting plasma glucose level of 126 mg/dL or more, or an official diagnosis. The research found that although the prevalence of diabetes remained largely unchanged, from 12.8% in 2013-2014 to 14.1% in 2021-2023, glycemic control had significantly declined.
Among those with diabetes, HbA1c levels remained stable between 2013 and 2020. However, a significant increase was observed from 7.31% in 2017-2020 to 7.60% in 2021-2023. The proportion of patients with good glycemic control (defined as an HbA1c level under 7%) also fell sharply, dropping from 54.3% in 2017-2020 to just 43.5% in 2021-2023. This deterioration was most pronounced in adults aged 20 to 44, a group that saw a notable decline in control rates not mirrored in other age or sex demographics.
The authors of the study suggest that the pandemic played a significant role in this decline. Increased sedentary behavior, lack of social support, and stress, coupled with reduced access to healthcare and medication, likely compounded the challenges faced by this age group in managing their diabetes effectively.
Given the growing body of evidence linking poor glycemic control to increased cardiovascular risks, the authors call for targeted public health and policy efforts aimed at improving diabetes management, particularly for younger adults. They emphasize that the stagnation in mortality improvement among young adults with diabetes necessitates urgent action to address this public health crisis.
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