CDC Survey Shows Age-Related Variability in Diabetes Management

Pharmacist and younger customer looking at medication boxYounger adults with diabetes (age 18 to 39 years) are less likely than older patients to take medication to control their glucose levels or to see a doctor biannually, according to a National Health Interview Survey (NHIS) Data Brief. Types of treatments use also varied by age with younger adults more likely to take insulin alone.

“The findings show that younger aged adults with diagnosed diabetes are consistently more likely to be missing out on important preventive clinical management of diabetes compared to those who are older,” said lead author of the Data Brief Maria A. Villarroel, PhD, Research Fellow, Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). “We found that adults aged 18 to 39 years were less likely to have been examined by an eye doctor, foot specialist, or to have been monitored for cardiovascular or nephropathy risk factors compared to those 40 and older. Furthermore, contact with any health care professional, specialist in eye or foot care, and the monitoring of blood pressure or cholesterol levels decreased with age among adults with diagnosed diabetes,” Dr. Villarroel said.

The report “tells us that [the percentage of] people seeking medical care is remarkably high after a diagnosis of diabetes is made, including care from foot and eye doctors, and that in the younger age group where the information might be more valuable for preventing problems, not enough people pay attention to blood pressure and cholesterol levels,” commented Gerald Bernstein, MD, FACP, Director, Diabetes Management Program, Mount Sinai Beth Israel. “This is a dramatic difference from what was seen a couple of decades ago when the number of people seeking care was much lower,” Dr. Bernstein said.

“We can therefore conclude that progress and awareness of diagnosis and treatment is a major accomplishment,” Dr. Bernstein said. “It has not been easy for the CDC and all organizations involved with diabetes care because of the restrictive reimbursement especially for diabetes education,” he added.

Survey Included More Than 3,500 Patients with Diabetes
The NHIS is conducted continuously throughout the year by the CDC’s National Center for Health Statistics. Patients are interviewed in their homes and followup interviews may be conducted over the telephone.

Of the 34,525 persons aged 18 and over who participated in NHIS in 2013, 3,589 had ever been diagnosed with diabetes and were included in the analysis. As shown in Figure 1, the percentage of diagnosed diabetes was lowest among adults aged 18 to 39 years and rose to 11% among those aged 40 to 64 years, and to 21% among those age 65 years and older.

Figure 1. Percentage of adults aged 18 and over with diagnosed diabetes, by age group: United States, 2013. Estimates for the three age groups were significantly different from each other (P<0.05). A linear increase with age in the percentage of adults with diagnosed diabetes was statistically significant (P<0.05).
SOURCE: CDC/NCHS, National Health Interview Survey, 2013.

The percentage of patients not complying with the American Diabetes Association’s recommendation to meet with their doctor biannually decreased with age, from a high of 19% among adults aged 18 to 39 years to 11% among those aged 40 to 64 years and 7% among those aged 65 and older (Figure 2).

Figure 2. Percentage of persons who had contact with a doctor or health care professional about their own health in the past 6 months, among adults with diagnosed diabetes, by age group: United States, 2013. Estimates for the three age groups were significantly different from each other (P<0.05).
SOURCE: CDC/NCHS, National Health Interview Survey, 2013.

Types of Treatment Differ by Age
Nearly 30% of younger adults were not taking any diabetes medication, compared with 14.3% of adults aged 40 to 64 and 13.5% of adults aged 65 and older.

“It is recommended that glycemic levels should be evaluated in a clinical setting at least biannually,” Dr. Villarroel said. “We found that younger aged adults were more likely to not have talked to a health care professional about their own health in the past 6 months.  One inference from such finding is that younger aged adults with diagnosed diabetes might be also more likely to not have had the opportunity to have been administered a laboratory evaluation of their glycemic levels to assess whether diabetes medication might be needed. This is of concern because it suggests that younger aged adults with diagnosed diabetes have a decreased opportunity to interact with health care professionals who not only can help patients control glucose levels, but also monitor risk factors of diabetes related complications,” Dr. Villarroel said.

Among patents taking diabetes medications, the type of treatment differed by age. Adults aged 18 to 39 years with diagnosed diabetes were more likely than those aged 40 years and older to take insulin alone to control their glucose levels (Figure 3). Adults aged 40 and older were more likely to use both insulin and oral medications than those aged 18 to 39 years. The use of oral medications alone to control blood glucose levels increased with age.

Figure 3. Percent distribution of diabetes medication use among adults with diagnosed diabetes, by age group: United States, 2013. Estimates for adults aged 18–39 were significantly different from those of adults aged 40–64 for all four medication categories, and from those of adults aged 65 and over for pills only, insulin only, and not currently taking medication (P<0.05). Estimates for adults aged 40–64 were significantly different from those of adults aged 65 and over for pills only (P<0.05).
SOURCE: CDC/NCHS, National Health Interview Survey, 2013.

Younger Patients Less Likely to Have Blood Pressure, Cholesterol Levels Checked
Although the majority of respondents had their cholesterol levels and blood pressure checked during the past 12 months, those age 18 to 39 years were less likely to have received these measures (72% for blood cholesterol and 90% for blood pressure) checked than adults aged 40 and older (90% and 95%-97%, respectively).

Similarly, younger adults were less likely to see an eye (35.9% vs 54%-65%) or foot specialist (11% vs 19%-28%) in the past year.

A Call For Increased Diagnosis of Prediabetes
“What this report doesn’t tell us that this is the tip of the iceberg, and underneath are millions of people with prediabetes, most of whom are not diagnosed,” Dr. Bernstein commented. “During the prediabetes phase there is festering deterioration, especially the cardiovascular system so that by the time the diagnosis of clinical diabetes is made, many already have impairment that was preventable. Like the measles, if we don't prevent the diseases, there will be serious medical and economic consequences. Let us take the CDC report as an indication that with the right effort we can screen for and detect prediabetes and forestall the appearance of diabetes,” Dr. Bernstein said.

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