Trends in the diabetes care cascade among U.S. adults with heart failure
Y RazaAbstract
Background
Diabetes is a common comorbidity in heart failure (HF) and contributes to adverse outcomes. Whether diabetes treatment and glycaemic control have improved over time among adults with HF is uncertain.
Purpose
To evaluate temporal trends in the diabetes care cascade (treatment, HbA1c control, and treated+controlled) among U.S. adults with self-reported HF and diagnosed diabetes.
Methods
National Health and Nutrition Examination Survey (NHANES) 2003-2018 data were analysed. Adults (≥20 years) with self-reported HF and diagnosed diabetes were included. Diabetes treatment was defined as self-reported insulin use and/or use of diabetes pills. Glycaemic control was defined as HbA1c <7.0%. Survey-weighted prevalence was estimated by 4-year periods (2003-2006, 2007-2010, 2011-2014, 2015-2018) accounting for the complex survey design; subpopulation (domain) estimation was used with adjustment for single-PSU strata.
Results
Unweighted sample sizes were n=147 (2003-2006), n=160 (2007-2010), n=156 (2011-2014), and n=185 (2015-2018). Among adults with HF and diagnosed diabetes, the prevalence of diabetes pharmacologic treatment increased from 77.5% (95% CI 64.9-90.1) in 2003-2006 to 91.3% (86.0-96.6) in 2015-2018. In contrast, HbA1c control (<7.0%) declined from 60.2% (49.1-71.2) to 48.7% (38.0-59.3). The proportion achieving both treatment and HbA1c control remained low and largely unchanged across time: 40.3% (30.2-50.4) in 2003-2006, 44.1% (33.9-54.3) in 2007-2010, 38.6% (26.6-50.5) in 2011–2014, and 40.2% (31.0-49.3) in 2015-2018.
Conclusion
In U.S. adults with HF and diagnosed diabetes, diabetes treatment rates were high and increased over 2003-2018, yet glycaemic control worsened and only approximately 4 in 10 achieved both treatment and HbA1c <7.0% throughout. These findings highlight persistent gaps in effective diabetes management among adults with HF and support intensified strategies to improve glycaemic control in this high-risk population.Diabetes care cascade in HFFor image description, please refer to the figure legend and surrounding text.