Unmet Care Targets Suggest Need for Improved Diabetes Care Accessibility

Despite advances in therapies for diabetes, those living with the disease are not faring better in reaching treatment targets due to lack of access to care, starting with the ability to be properly diagnosed.

Although millions of Americans live with diabetes, diabetes care targets continue to go unmet due to a lack of accessibility to care among patients, with insurance coverage playing a key role, according to findings appearing last week in JAMA Internal Medicine.

The research examined data from the 2005-2016 National Health and Nutrition Examination Survey to determine whether US diabetes care—defined as diabetes diagnosis, linkage to care, and achievement of individual and combined treatment targets—had improved over time. The individual treatment targets are achieving a glycated hemoglobin <7.0%-8.5%, depending on age and complications; maintaining blood pressure <140/90 mm Hg; and maintaining low-density lipoprotein cholesterol <100 mg/dL, as well as abstaining from smoking. A composite measure tracked the ability to achieve all 4 targets.

The analysis revealed that more than 1 in 4 adults with diabetes were not diagnosed and nearly 1 in 3 were not receiving appropriate care for their diabetes. Furthermore, middle-aged adults and older patients had higher odds of meeting the composite target than younger adults. Also, women had lower odds of achieving the composite target than men, and non-Hispanic black individuals vs non-Hispanic white individuals had lower odds of reaching the target.

“Fewer than 1 in 4 American adults with diagnosed diabetes achieve a controlled level of blood sugar, blood pressure, and cholesterol and do not smoke tobacco. Our results suggest that, despite major advances in diabetes drug discovery and movement to develop innovative care delivery models over the past 2 decades, achievement of diabetes care targets has not improved in the United States since 2005," author Pooyan Kazemian, PhD, of the MGH Medical Practice Evaluation Center, and instructor in Medicine at Harvard Medical School (HMS) said in a statement.

Despite the advancements in screenings and interventions, there needs to be improved approaches for diabetes care delivery, specifically for reaching populations with disparities in care, the authors said. The researchers found that insurance coverage was the strongest indicator of diagnosis, linkage, and achievement of the treatment targets, demonstrating a clear need for improved accessibility to care.

"Treatment advances in diabetes mellitus can meaningfully improve outcomes only if they effectively reach the populations at risk,” concluded senior author Deborah J. Wexler, MD, MSc, of the MGH Diabetes Unit, and associate professor in Medicine at HMS. “Our findings suggest this is not the case in the U.S. and indicate an immediate need for better approaches to diabetes care delivery including a continued focus on reaching underserved populations with persistent disparities in care,"


Kazemian P, Shebl F, McCann N, et al. Evaluation of the cascade of diabetes care in the United States, 2005-2016 [published online August 12, 2019]. JAMA Internal Medicine.