美国成年人糖尿病治疗和控制的趋势，1999-2018 年。
Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018.
机构信息
From the Welch Center for Prevention, Epidemiology, and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.
出版信息
N Engl J Med. 2021 Jun 10;384(23):2219-2228. doi: 10.1056/NEJMsa2032271.
BACKGROUND
Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning.
METHODS
We conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018.
RESULTS
Diabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007-2010 period and the 2015-2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non-high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007-2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015-2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011-2014 to 2015-2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015-2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure-lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control.
CONCLUSIONS
After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off. (Funded by the National Heart, Lung, and Blood Institute.).
背景
记录糖尿病治疗和风险因素控制方面的当前趋势，可能有助于制定公共卫生政策和规划。
方法
我们对参与美国国家健康和营养检查调查（NHANES）的糖尿病成年患者的数据进行了横断面分析，以评估 1999 年至 2018 年期间糖尿病治疗和风险因素控制方面的全国趋势。
结果
在参与者中，糖尿病控制情况从 1999 年至 2010 年初有所改善，但随后停滞不前并出现下降。在 2007-2010 年期间和 2015-2018 年期间，NHANES 参与者中血糖控制（糖化血红蛋白水平，<7%）达到目标的成年人比例从 57.4%（95%置信区间[CI]，52.9 至 61.8）下降至 50.5%（95%CI，45.8 至 55.3）。在 2000 年代初血脂控制（非高密度脂蛋白胆固醇水平，<130mg/dL）取得重大改善后，从 2007-2010 年（52.3%；95%CI，49.2 至 55.3）到 2015-2018 年（55.7%；95%CI，50.8 至 60.5），仅有微小改善。从 2011-2014 年到 2015-2018 年，血压控制（<140/90mmHg）达到目标的参与者比例从 74.2%（95%CI，70.7 至 77.4）降至 70.4%（95%CI，66.7 至 73.8）。2010 年后，同时达到三个目标的参与者比例趋于平稳，在 2015-2018 年为 22.2%（95%CI，17.9 至 27.3）。2010 年后，使用任何降糖药物或任何降压药物的参与者比例保持不变，使用他汀类药物的比例在 2014 年后趋于平稳。在 2010 年后，血压控制未达标的参与者中联合治疗的使用有所下降，血糖控制不佳的参与者中联合治疗的使用则保持平稳。
结论
在 1999 年至 2010 年初取得超过十年的进展之后，NHANES 中患有糖尿病的成年参与者的血糖和血压控制情况恶化，而血脂控制水平则趋于平稳。（由美国国家心肺血液研究所资助）。
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