American Diabetes Association
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Trends in Receipt of American Diabetes Association Guideline-Recommended Care Among U.S. Adults With Diabetes: NHANES 2005–2018

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posted on 2021-04-16, 16:08 authored by Jung-Im Shin, Dan Wang, Natalie Daya, Morgan E. Grams, Sherita H. Golden, Swapnil Rajpathak, Elizabeth Selvin
Objective: To characterize national trends and characteristics of adults with diabetes receiving American Diabetes Association (ADA) guideline-recommended care.

Research Design and Methods: We performed serial cross-sectional analyses of 4,069 adults aged≥20 years with diabetes who participated in the 2005-2018 National Health and Nutrition and Examination Survey (NHANES)

Results: Overall, the proportion of US adults with diabetes receiving ADA guideline-recommended care (meeting all five criteria (self-report) in the past year: having a primary doctor for diabetes and number of visits for this doctor≥1; HbA1c testing; an eye exam; a foot exam; and cholesterol testing) increased from 25.0% in 2005-2006 to 34.1% in 2017-2018 (P-trend=0.004). For participants with age≥65 years, it increased from 29.3% in 2005-2006 to 44.2% in 2017-2018 (P-trend=0.001), whereas for participants with age 40-64 and 20-39 years, it did not change significantly during the same time period: 25.2% to 25.8% (P-trend=0.457) and 9.9% to 26.0% (P-trend=0.401), respectively. Those who were not receiving ADA guideline-recommended care were more likely to be younger, of lower socioeconomc status, uninsured, newly diagnosed with diabetes, not on diabetes medication, and free of hypercholesterolemia.

Conclusions: Receipt of ADA guideline-recommended care increased only among adults with diabetes aged ≥65 years in the past decade. In 2017-2018, only 1 out of 3 US adults with diabetes reported receiving ADA guideline-recommended care, with even a lower receipt of care among those<65 years of age. Efforts are needed to improve healthcare delivery and equity in diabetes care. Insurance status is an important modifiable determinant of receiving ADA guideline-recommended care.


The project described was supported by a research grant from Merck to Johns Hopkins Bloomberg School of Public Health (PI: Dr. Shin) and K01DK121825 (PI: Dr. Shin) from the National Institute of Diabetes and Digestive and Kidney Disease.


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