上海交通大学医学院王慧教授团队等研究了1999-2018年美国成年人糖尿病患病率趋势和糖尿病危险因素控制情况。相关论文于2021年6月25日发表在《美国医学会杂志》上。

了解全人口范围内糖尿病的流行和控制趋势，对于规划预防和管理这一疾病的公共卫生方法至关重要。

为了确定1999-2000年至2017-2018年美国成年人糖尿病流行趋势和糖尿病风险因素控制情况，研究组对1999-2000年至2017-2018年10个周期的美国健康和营养检查调查（NHANES）横断面数据进行了分析。研究样本被加权，以代表美国非机构居民人口，包括除孕妇外的18岁及以上成年人。

糖尿病定义为糖尿病诊断的自我报告，空腹血糖水平为126 mg/dL及以上，或糖化血红蛋白（HbA1c）水平为6.5%及以上。三个危险因素控制目标分别为个体化的HbA1c目标、血压低于130/80 mmHg和低密度脂蛋白胆固醇水平低于100 mg/dL。通过总体和社会人口统计变量来估计糖尿病患病率和实现危险因素控制目标的成年糖尿病患者的比例。

28143名参与者的加权平均年龄为48.2岁，其中49.3%为男性，估计年龄标准化糖尿病患病率从1999-2000年的9.8%显著增加到2017-2018年的14.3%。从1999-2002年至2015-2018年，估计年龄标准化确诊糖尿病成人实现血压低于130/80 mmHg和低密度脂蛋白胆固醇水平低于100 mg/dL目标的比例显著增加，但个体化的糖化血红蛋白目标却无显著变化。

2015-2018年，分别有66.8%、48.2%和59.7%的成人糖尿病患者实现了个体化HbA1c目标、血压低于130/80 mmHg和低密度脂蛋白胆固醇低于100 mg/dL的目标。仅有21.2%的成人同时实现了这三个目标。在整个研究期间，这3个目标在18至44岁的年轻人、非西班牙裔黑人成人和墨西哥裔美国成人中实现的可能性显著降低。

研究结果表明，根据NHANES来自美国成年人的数据，1999-2000年至2017-2018年间，糖尿病的估计患病率显著增加。2015-2018年，估计只有21%的成年糖尿病患者实现了所有3个风险因素控制目标。

附：英文原文

Title: Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Author: Li Wang, Xiaoguang Li, Zhaoxin Wang, Michael P. Bancks, Mercedes R. Carnethon, Philip Greenland, Ying-Qing Feng, Hui Wang, Victor W. Zhong

Issue&Volume: 2021-06-25

Abstract:

Importance  Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease.

Objective  To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018.

Design, Setting, and Participants  Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women.

Exposures  Survey cycle.

Main Outcomes and Measures  Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated.

Results  Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend <.001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend=.007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend <.001) increased significantly, but not individualized HbA1c targets (P for trend=.51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]).

Conclusions and Relevance  Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

DOI: 10.1001/jama.2021.9883

Source: https://jamanetwork.com/journals/jama/fullarticle/2781620