OBJECTIVES:To examine national trends over the past 18 years in the quality of diabetes care among US adults with diabetes.

METHODS:Individuals with diabetes aged 20 years or older from NHANES (1999 -2016) were included in the analysis. Quality indicators for diabetes care included Hemoglobin A1c (HbA1c) < 8%, Blood Pressure (BP) < 130/80 mmHg, Low-Density Lipoprotein (LDL-C) < 100 mg/dL, triglycerides < 150 mg/dL, receipt of eye and foot examinations in the past year, and meeting with a diabetes educator in the past year.

RESULTS:A total of 7,521 adults with diabetes were identified. The study sample was found to be predominantly old (mean age = 62.8 years), male (51.2%), Whites (61.0%), and with some form of health insurance (87.8%). During The study period, the overall quality of diabetes care was found to have significantly improved in the study sample. This improvement was observed in achieving HbA1c goal (from 71.9% to 79.9%; P_trend <0.0001), BP control (from 42.3% to 51.2%; P_trend=0.0003), LDL-C goal (from 31.9% to 52.5%; P_trend=0.0001), triglycerides goal (from 45.4% to 58.8%; P_trend=0.00095), and meeting with a diabetes educator (from 35.6% to 40.8%; P_trend=0.0132). Blacks and Hispanics experienced significant increase in rates of achieving most treatment goals over the 18-year study period. However, by the last survey cycle (2015-2016), substantial disparities in the quality of diabetes care persisted between Whites and these minority groups. Furthermore, lack of health insurance, lower educational attainment and presence of obesity and chronic kidney disease were found to be strong predictors of quality of diabetes care.

CONCLUSIONS:The quality of diabetes care in US adults has experienced substantial improvement in the past few decades. Nevertheless, gaps between certain minority groups and Whites still remain a critical issue. Future studies should explore all aspects of these disparities to improve outcomes of diabetes care.