Thirty-year Trends in Complications in U.S. Adults With Newly Diagnosed Type 2 Diabetes
Research design and methods: We included 1,486 nonpregnant adults (aged≥20 years) with newly diagnosed diabetes (diagnosed within the past 2 years) from the 1988-1994 and 1999-2018 National Health and Nutrition Examination Survey. We estimated trends in albuminuria (albumin-to-creatinine ratio≥30 mg/g), reduced estimated glomerular filtration rate (eGFR<60 ml/min/1.73 m2), retinopathy (any retinal microaneurysms or blot hemorrhages), and self-reported cardiovascular disease (history of congestive heart failure, heart attack, or stroke).
Results: From 1988-1994 to 2011-2018, there was a significant decrease in the prevalence of albuminuria (38.9 to 18.7%, p-for-trend<0.001), but no change in the prevalence of reduced eGFR (7.5 to 9.9%, p-for-trend=0.30), retinopathy (1988-1994 to 1999-2008 only; 13.2 to 12.1%, p-for-trend=0.86), or self-reported cardiovascular disease (19.0 to 16.5%, p-for-trend=0.64). There were improvements in glycemic, blood pressure, and lipid control in the population, and these partially explained the decline in albuminuria. Complications were more common at the time of diabetes diagnosis for adults who were older, lower income, less educated, and obese.
Conclusion: Over the past three decades, there have been encouraging reductions in albuminuria and risk factor control in adults with newly diagnosed diabetes. However, the overall burden of complications around the time of diagnosis remains high.