Trends in Diabetes Management Among US Adults: 1999–2016

  • Michael FangEmail author
Original Research



Updating national trends in diabetes management is important for identifying areas of progress and remaining gaps in diabetes care.


Evaluate trends in diabetes management.


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.


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).


Despite notable improvements, declines in glycemic control and adherence to dietary recommendations may be growing challenges in diabetes care.


diabetes mellitus risk factor control social disparities 



The author thanks Dr. Elizabeth Selvin for sharing her NHANES dataset that contained calibrated values for HbA1c.

Funding Information

Dr. Fang was supported by NIH/NHLBI grant T32 HL007024.

Compliance with Ethical Standards

Conflict of Interest

The author declares that he does not have a conflict of interest.

Supplementary material

11606_2019_5587_MOESM1_ESM.docx (58 kb)
ESM 1 (DOCX 58.0 kb)


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Copyright information

© Society of General Internal Medicine 2020

Authors and Affiliations

  1. 1.Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins UniversityBaltimoreUSA

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