Diabetes control declines among U.S. adults after years of stability

Author(s):

Austin Littrell

Key Takeaways

Diabetes prevalence in U.S. adults remained stable, but glycemic control worsened, especially in younger adults aged 20-44.
The proportion of diabetes patients with HbA1c below 7.0% decreased significantly, indicating poorer glycemic control.
Younger adults face greater healthcare access barriers, exacerbated by the pandemic, leading to increased HbA1c levels.
Worsening glycemic control heightens the risk of diabetes complications, highlighting the importance of early intervention and management.

A research letter published in JAMA noted that young adults saw the largest drop in glycemic control from 2021-2023.

A new study published in JAMA finds that, although the overall prevalence of diabetes among U.S. adults has remained steady over the past decade, glycemic control has worsened — especially among younger adults.

Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2023. The study included 24,263 U.S. adults, with 4,623 identified as diabetic. Despite expectations that disruptions in health care access during the COVID-19 pandemic might have affected diabetes prevalence, the data showed little fluctuation.

The prevalence of diabetes stood at 12.8% in 2013-2014 and 14.1% in 2021-2023 — a statistically insignificant difference.

However, the study identified a troubling decline in glycemic control among those diagnosed with diabetes. Between 2017-2020 and 2021-2023, the proportion of diabetes patients with an HbA1c below 7.0% — the standard threshold for adequate control — fell from 54.3% to 43.5%. Average HbA1c levels also increased significantly from 7.31% to 7.60% over the same period.

Young adults face the biggest challenges

The decline in glycemic control was most striking among adults aged 20-44. In this group, mean HbA1c levels rose from 7.43% in 2017-2020 to 8.51% in 2021-2023. Meanwhile, the percentage of young adults meeting the HbA1c target fell from 57.4% to 37.1%. Similar patterns were not observed among older adults.

The researchers noted that younger individuals with diabetes may have faced greater barriers to health care access and medication adherence, particularly during the pandemic. Although Medicare ensures near-universal coverage for older adults, younger populations often experience insurance gaps, job-related instability, and disruptions in care.

The authors suggest several potential factors contributing to worsening levels of glycemic control, including increased sedentary behavior, reduced social support, heightened mental health stressors, and limited access to health care and medications — challenges which were exacerbated by the pandemic.

Past research has indicated that younger adults with diabetes were more likely than their older counterparts to report disruptions in care and difficulty obtaining medications.

Worsening glycemic control increases patients’ lifetime risk of developing diabetes complications, including cardiovascular disease, kidney disease and neuropathy. A previous meta-analysis linked a 1% increase in HbA1c with a higher risk of adverse cardiovascular outcomes, underscoring the need for early intervention and condition management.