Individuals with diabetes (DM) are at high risk of heart attack and other diabetes complications. Control of Hemoglobin A1c, Blood Pressure, and Cholesterol (ABC) can be effective in preventing these complications. However, studies that assess the state-level prevalence of ABC control within the DM population are lacking. This study aims to estimate the state-level proportions of adults with self-reported diagnosed DM meeting the goals of ABC control in the 50 U.S. states and the District of Columbia. We applied weighting adjustments to data from 2013-2016 National Health and Nutrition Examination Survey (NHANES), 2016 American Community Survey (ACS), and 2016 Behavioral Risk Factor Surveillance System (BRFSS) to create state-level estimates. To adjust NHANES national weights to reflect the demographic characteristics of states, we used raking to adjust BRFSS weights to the ACS on age, sex, race, health insurance status, education and income, and then used the propensity score method to adjust NHANES to the ACS-adjusted BRFSS on these variables plus self-reported overall health status. We defined ABC control as A1C < 9%, blood pressure (BP) < 140/90 mmHg, and non-HDL cholesterol (non-HDL-C) < 130 mg/dL. Among adults with DM, 38% (95% CI 30.8%-45.2%) of patients met the goal of ABC control, with the highest rate of 43.7% (36.1%-51.3%) in South Dakota and the lowest rate of 32.9% (27.3%-38.5%) in the District of Columbia. Control rates of A1C were highest in each state, followed by BP and non-HDL-C. Overall, 86.6% (82.3%-90.9%) of patients had controlled A1C, 72.6% (67.0%-78.2%) had controlled BP, and 58.7% (52.9%-64.5%) had controlled non-HDL-C. Control rates for each individual goal varied by state. ABC control is suboptimal among adults with DM and varies by state. Our estimates provide data that public health departments could use in their planning efforts to improve ABC control and thus reduce DM-related complications at the state level.


Y. Chen: None. D.B. Rolka: None. H. Xie: None. S. Saydah: None.

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