More patients with diabetes are meeting targets than was the case a decade ago, but there is still room for improvement, especially within certain subgroups, researchers found.

About half of patients met goals for glycated hemoglobin (HbA1c), blood pressure, and LDL cholesterol, up from 43%, 33%, and 10% more than 10 years ago, according to an analysis of data from several periods of the National Health and Nutrition Examination Survey (NHANES).

But “almost half of Americans with diabetes did not meet each ABC [A1c, Blood pressure, and Cholesterol] goal, and 81.2% did not achieve all three goals,” Sarah Stark Casagrande, PhD, of Social & Scientific Systems, Inc., of Silver Spring, Md., and colleagues reported in Diabetes Care.

And groups such as Mexican Americans and blacks were still disproportionately affected, they wrote.

The analysis, supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), looked at data on 4,926 adults with diabetes from several periods of NHANES between 1988 and 2010. In the most recent time period (2007-2010), the proportion of patients hitting the ABC targets improved significantly over the showing in 1988-1994, the first NHANES period assessed:   HbA1c below 7%—52.5% versus 43% (P<0.01) Blood pressure below 130/80 -- 51.1% compared with 33.2% (P<0.05) LDL cholesterol below 100 mg/dL -- 56.2% versus 9.9% (P<0.01) All three targets -- 18.8%, up from 1.7% (P<0.01) Statin use also rose significantly during that time, from 4.2% to 51.4% (P<0.01), the researchers reported, but they noted that half of diabetes patients are still not meeting the majority of the targets, including statin use, which leaves "room for improvement." Certain subgroups also appeared to be less likely to achieve the targets, they found. For instance, Mexican Americans were significantly less likely than whites to meet HbA1c and LDL goals (P<0.03) and blacks were less likely than whites to meet blood pressure and LDL goals (P<0.02).

Mexican Americans were also less likely to meet HbA1c goals than blacks (P<0.01). "Not only do Mexican-Americans and non-Hispanic blacks have higher rates of diabetes, members of these groups who develop diabetes also have poorer health outcomes," Casagrande said in a statement. "While diabetes control has improved in these populations, some disparities remain, demonstrating the need for improved management of the disease to prevent its devastating complications." Tom Brooks Vaughan, MD, of the University of Alabama at Birmingham, noted that there had been little improvement over the last two NHANES periods assessed in the trial. "There's been improvement but the pace seems to have slowed," Vaughan, who wasn't involved in the study, told MedPage Today. He believes that may have something to do with patients' access to healthcare. "With people who see me regularly, generally I'm able to meet most of these goals," he said. "But folks who don't come, or lose insurance, or have difficulty affording their medications, clearly they're harder to treat and that may be part of the problem." The researchers also called it "noteworthy" that younger patients were less likely to meet HbA1c and LDL goals. It may be that this population included more patients with type 1 diabetes, which is more difficult to control, or it could be an indicator of survival bias, they wrote. "As the U.S. population ages and diabetes prevalence increases, it becomes increasingly urgent to find ways to overcome barriers to good diabetes management and deliver affordable, quality care so those with diabetes can live a longer and healthier life without serious diabetes complications," Casagrande and colleagues wrote. Judith Fradkin, MD, of the NIDDK, commented particularly on the figures for younger patients. "It is particularly disturbing that good control was seen less frequently in young people," Fradkin said in a statement. "Research has shown that good diabetes control early in the course of disease has long-lasting benefits reducing the risk of complications. For people with long life expectancy after diagnosis of diabetes, it's especially important to focus on meeting diabetes management goals as early as possible, because with that longer life comes a greater chance of developing complications if they do not control their diabetes." UPDATE: This article originally published at 1:30 p.m. on Feb. 15, was updated with new material at 5:30 p.m. ### By Kristina Fiore, Staff Writer, MedPage Today