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Invited Commentary
August 12, 2019

Age and Age-old Disparities in Diabetes Care Persist

Author Affiliations
  • 1Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
  • 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
JAMA Intern Med. 2019;179(10):1386-1387. doi:10.1001/jamainternmed.2019.2392

As the morbidity, mortality, and costs of diabetes grow nationwide, a new analysis by Kazemian and colleagues published in this issue of JAMA Internal Medicine1 shows that average-care goal achievement among adults with diabetes has remained stagnant over the past 12 to 15 years. Expanding on a previous report,2 this study used data from the 2005-2008, 2009-2012, and 2013-2016 cycles of the National Health and Nutrition Examinations Survey to describe the care continuum from diagnosis to combined achievement of cardiometabolic care goals. The findings show that among American adults with fasting glucose-defined and hemoglobin A1c (HbA1c)–defined diabetes, more than one-quarter were undiagnosed. Among those with diagnosed diabetes, 64% achieved individualized glycemic control targets based on age and comorbidities, 70% met blood pressure targets, 57% met a broad cholesterol goal of taking statins and/or meeting low-density lipoprotein cholesterol targets, and 85% were nonsmokers. An estimated 23% met all 4 care goals. The estimates remained stable over the study period. Of note, young adult, women, non-Hispanic black, and uninsured respondents fared worse than their counterparts. This report brings to light a number of key disparities and important challenges in trying to close care gaps, especially in the context of diverse, market-based health care delivery in the United States.

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