- The proportion of patients with type 2 diabetes who have control of their blood sugar has stayed constant over the past 30 years despite the availability of new technologies, according to a paper published in JAMA Network Open.
- Analyzing data collected by the National Health and Nutrition Examination Survey (NHANES), researchers at Johns Hopkins showed the proportion of patients with glycemic control fell just 1.7 percentage points in the past three decades, from 29.2% between 1988 and 1994 to 27.5% between 2013 and 2020.
- The researchers tracked rises in racial and ethnic disparities over the 30-year period, showing that rates of glycemic control fell in Mexican-American and non-Hispanic Black adults while they rose among non-Hispanic white adults.
Since 1988, advances in insulin delivery and formulations, coupled with new technologies for monitoring blood glucose, have theoretically made it easier for people with type 2 diabetes to control their blood glucose levels. While companies have shown improvements in controlled clinical trials for glycemic control, it has been unclear whether patients have realized significant benefits in the real world.
The Johns Hopkins study sought to clear up that uncertainty by analyzing NHANES data collected across two time periods, 1988 to 1994 and 1999 to 2020. The dataset featured 2,482 participants with diabetes using insulin.
The analysis showed that the percentage of non-Hispanic white adults achieving glycemic control increased from 27.7% between 1988 and 1994 to 32.9% between 2017 and 2020. However, glycemic control rates in Mexican- American and non-Hispanic Black adults fell significantly over the same period, slipping from 25.1% to 9.9% and from 31.8% to 22.9%, respectively. Overall, glycemic control rates fell slightly.
It is unclear why glycemic control rates fell. The researchers proposed three possible explanations: rising insulin costs are leading to medication nonadherence; delays to the initiation or intensification of insulin therapy; and the reluctance of patients to use insulin therapy as recommended.
Medtech companies are already trying to address some of the potential causes of low glycemic control rates by making it easier for patients to manage insulin therapy. Novo Nordisk recently acknowledged some of the challenges patients face by expanding its digital insulin initiation and titration app alliance.