Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: Comparison by prevalent cardiovascular disease status

Background: Most patients with type 2 diabetes mellitus (T2DM) suffer from cardiovascular disease (CVD). Whether CVD risk factors have improved in those with DM with and without CVD is not established. We compared risk factor levels and goal attainment in US adults with diabetes with and without CVD. Methods: We examined 2403 adults (aged 18 years) in the United States with T2DM (n = 654, 27% with CVD) across 1999-2010 using the US National Health and Nutrition Examination Survey (NHANES) and evaluated control of hemoglobin A(1c) (HbA(1c)), blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in those with DM with versus without CVD. Results: The proportions controlled for HbA(1c), BP and LDL-C have improved (p < 0.001) overall between 1999 and 2010, but only 24% were at goal for all three factors in 2009-2010. There were improvements in BP, triglycerides and LDL-C in those with CVD, and in those without CVD, there were also improvements in control of all parameters, although changes in mean levels of risk factors were less impressive. Conclusion: Despite modest improvement over time, in most CVD risk factors, only one-fourth of those with T2DM are at goal for HbA(1c), BP and LDL-C, with improvements seen in those without CVD more often than those with CVD.