Summary

Individuals diagnosed with diabetes often take medications to control and manage their diabetes and engage in self-care practices. Among adults with diagnosed diabetes in the United States, 88.2% use either oral medications, insulin, or a combination of both to treat and control diabetes. Diabetes treatment patterns differ by demographics, duration since diabetes diagnosis, and glycosylated hemoglobin (A1c) levels. Adults with diabetes often have a number of comorbid conditions that require treatment and medications. An adult with diagnosed diabetes in the United States reports using an average of 5.9 different prescription medications. This number is higher than the average reported by adults with undiagnosed diabetes, prediabetes, or no diabetes (range 2.5–4.3). Diabetes self-care practices are also an important component of diabetes treatment. The majority of adults with diagnosed diabetes report self-care practices, such as receiving a dilated eye exam (62.8%), self-monitoring of blood glucose (63.6%), and receiving a foot exam (67.5%). Report of self-care practices differs by demographics, time since diabetes diagnosis, and geography. Pancreatic transplants and bariatric surgery are sometimes indicated for the treatment of diabetes. However, these procedures are not common and entail a number of additional risks. Describing medication use, treatment patterns, and self-care practices among individuals with diabetes provides information to health care and public health professionals to better understand the multifactorial aspects of diabetes treatment.

Introduction

Diabetes is a complex disease that often requires a person with diabetes to follow a number of self-care practices, such as taking medications to control and manage their diabetes. In addition, persons with diabetes often have comorbid chronic conditions, including cardiovascular disease (CVD), hypertension, and depression, which often require taking multiple medications. This chapter describes both trends and current medication use and self-care practices among persons with diabetes. The majority of the chapter focuses on previously diagnosed diabetes defined by self-report of diagnosis by a health care professional. To place medication use among adults with diagnosed diabetes in the context of the larger adult population, it also includes data on persons with no diabetes, prediabetes, and undiagnosed diabetes. Persons without diabetes or with prediabetes or undiagnosed diabetes are classified based on glycosylated hemoglobin (A1c) or fasting plasma glucose levels among adults without diagnosed diabetes.

Data Sources, Limitations

Information on medication use and self-care practices in the U.S. adult population comes from a number of national health surveys: the National Health and Nutrition Examination Surveys (NHANES) 1999–2010, the National Health Interview Surveys (NHIS) 1997–2010, and the Behavioral Risk Factor Surveillance System (BRFSS). The NHANES is a representative sample of the noninstitutionalized population in the United States and includes information collected from in-person interviews, physical examinations, and laboratory tests. In addition, detailed information on prescription medications is collected during home interviews from physical medication containers. Similar to the NHANES, the NHIS is a nationally representative survey of the noninstitutionalized population in the United States; information is collected from in-person interviews. The BRFSS is a telephone survey that collects information on health-related risk behaviors, chronic conditions, and use of preventive services. The BRFSS is conducted in all 50 states, the District of Columbia, and three U.S. territories.

The limitations of these surveys pertaining to diabetes treatment and self-care practices include the lack of information on adherence with prescribed medications, reliance on self-report and lack of supplementary information from medical records, and lack of inclusion of the institutionalized population, which includes nursing home residents (1). Both the NHIS and BRFSS have the additional limitation of not collecting any laboratory or examination data. However, the NHANES, NHIS, and BRFSS all provide valuable information related to the treatment and care of the population with diabetes in the United States.

Data presented in this chapter include new analyses of these national datasets conducted for Diabetes in America, 3rd edition, as well as national data published by the Division of Diabetes Translation of the Centers for Disease Control and Prevention. Data presented on pancreas and islet transplantation are based on the International Pancreatic Transplant Registry and the Collaborative Islet Transplant Registry.

Diabetes Treatment

Treatment for diabetes often focuses on many different facets of the disease and on controlling and preventing known diabetes complications. The first goal of treatment for diabetes is typically management of blood glucose levels. Glycemic control is associated with reduced risk of both microvascular and macrovascular complications among people with diabetes (2,3). Individuals with diabetes often have a number of comorbid conditions, including hypertension and elevated cholesterol levels, which may require control with medications to reduce the risk of complications (4,5,6).

Recommendations on medication use to treat diabetes depend upon the type of diabetes. Individuals with type 1 diabetes make little or no insulin and require daily insulin treatment to control and manage blood sugar levels, while individuals with type 2 diabetes still make insulin and may control blood glucose levels with no medication, oral medications, noninsulin injectable medications (such as glucagon-like peptide [GLP]-1 receptor agonists), insulin, or a combination of these.

In the United States from 2007 to 2010, 88.2% of persons age ≥20 years with diagnosed diabetes were treating their diabetes with insulin and/or oral medications: 58.4% were taking oral medications alone, 15.3% were taking insulin alone, and 14.5% were taking a combination of insulin and oral medications (Figure 39.1, Table 39.1). Patterns of diabetes treatment revealed many similarities and a few differences by demographic groups. Younger adults age <45 years were more likely than older adults to report using insulin alone (28.7%), possibly an indication of the low prevalence of type 2 diabetes and the higher prevalence of type 1 diabetes in this age group. Patterns of diabetes treatment by sex were similar. Patterns of diabetes treatment differed slightly by race/ethnicity. Non-Hispanic whites had the highest prevalence of insulin alone (18.3%) and combination of insulin and oral medication (16.2%). Mexican Americans had the lowest prevalence of use of insulin alone (10.1%), the highest prevalence of using oral medications alone (60.7%), the lowest prevalence of combined use of oral medication and insulin (11.0%), and the highest prevalence of no medication use (18.2%). Differences in patterns of diabetes treatment by demographic factors are shown in Table 39.1.

FIGURE 39.1

Prevalence of Diabetes Treatment Among Adults Age ≥20 Years With Diagnosed Diabetes, U.S., 2007–2010. Diabetes is self-reported. Estimates are weighted to the noninstitutionalized U.S. population.

Management of blood glucose levels is typically monitored by A1c level, an indicator of glycemic levels over the past 3 months. Standards of medical care for diabetes vary by individuals, and for many adults, the recommended A1c is <7.0% (<53 mmol/mol). Adults with higher A1c levels (≥8.0% [≥64 mmol/mol]) are more likely to be taking insulin alone or a combination of insulin and oral medication and least likely to be treating glucose levels with no medication. Duration of diabetes is also associated with diabetes treatment. Adults with duration of diabetes <10 years are most likely to use oral medication alone or no medication to treat diabetes (70.8% and 14.5%, respectively). Adults with duration of diabetes ≥10 years are least likely to use no medication for treatment (8.1%) (Table 39.1).

Oral Diabetes Medications

While 15.3% of adults age ≥20 years with diabetes use insulin alone and 11.8% use no medication, about 70% are using oral medications alone or in combination with insulin. In 2012, the American College of Physicians offered clinical practice guidelines on oral pharmacological treatment for diabetes (7,8). These guidelines provide a systematic review of the different treatment options. Treatment for type 2 diabetes often includes early initiation of multiple drugs (9).

Six different classes of oral medications are approved by the U.S. Food and Drug Administration (FDA) to target lower glucose levels: non-sulfonylureas, sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, and dipeptidyl peptidase-4 (DPP-4) inhibitors. Non-sulfonylureas (for example, metformin) are used most commonly by persons age ≥20 years with diagnosed diabetes (49.1%), followed by sulfonylureas (35.7%), thiazolidinediones (19.4%), and other oral diabetes medications (9.0%) (Table 39.2). Information on DPP-4 inhibitors is not collected in the NHANES. Patterns of types of oral medications used differ by age group. For example, use of sulfonylureas increases with age, with almost half of adults age ≥75 years reporting use of sulfonylureas compared to less than one-quarter of adults age 20–44 years. Similar patterns were reported by males and females. Hispanics, including Mexican Americans, had a lower prevalence of thiazolidinedione use compared to non-Hispanic whites and somewhat lower prevalence than that in non-Hispanic blacks (Table 39.2).

TABLE 39.1

Prevalence of Diabetes Treatment Among Adults Age ≥20 Years With Diabetes, U.S., 2007–2010.

Medication Use for Comorbid Conditions

Most patients with diabetes require control and management of comorbid conditions, in addition to control of glycemia. For example, individuals with diabetes have a higher prevalence of hypertension, elevated cholesterol (5,6), depression (18), and arthritis (19). These comorbidities often require separate medication for treatment. According to reports of prescription drugs from the NHANES 2005–2010, the age-standardized average number of prescription drugs in adults age ≥20 years with diabetes was 5.2, which is higher than the number of prescription drugs in those with undiagnosed diabetes (3.7), prediabetes (3.0), and no diabetes (2.6) (Figure 39.4 and Table 39.3, age-standardized; Appendix 39.1; Appendix 39.2, crude estimates).

Hypertension Treatment

Hypertension is highly prevalent in the U.S. population and even more common among adults with diabetes. Overall, among adults age ≥18 years in the United States in 2005–2008, the age-standardized prevalence of hypertension, based on current medication use for hypertension or blood pressure >140/90 mmHg, was 29.9% (20). In 2001–2008, the age-standardized prevalence of hypertension among adults with diagnosed diabetes was 67.3% (21). In 2005–2010, 57.9% of adults with diagnosed diabetes and 40.1% of adults with undiagnosed diabetes self-reported hypertension (Table 39.3, age-standardized; Appendix 39.2, crude estimates). This prevalence was much higher than self-report of hypertension among adults with prediabetes (33.7%) or no diabetes (24.1%) (Table 39.3, age-standardized; Appendix 39.2, crude estimates).

Controlling hypertension is important to prevent CVD events, kidney disease, and retinopathy (4,22,23,24). In 2005–2010 among adults age ≥20 years with diagnosed diabetes, 60.4% reported taking any medication typically prescribed for hypertension (Table 39.3, age-standardized; Appendix 39.2, crude estimates). Prevalence of hypertension medication use, based on a survey of prescription medications in the NHANES, increased across the spectrum of diabetes status, as defined by increasing glucose levels from no diabetes to undiagnosed diabetes. Adults age ≥20 years with no diabetes had the lowest hypertension medication use (17.9%), followed by adults with prediabetes (29.3%). Adults with undiagnosed diabetes, as defined by not self-reporting diagnosis but having blood glucose levels that indicated diabetes, also had a high prevalence of any hypertension medication use (34.9%) (Table 39.3, age-standardized; Appendix 39.2, crude estimates).

TABLE 39.2

Prevalence of Oral Diabetes Medications Among Adults Age ≥20 Years With Diabetes, U.S., 2005–2010.

FIGURE 39.2

Number in Millions of Adults Age ≥20 Years With Diabetes, by Diabetes Medication Status, U.S., 1997–2009. Diabetes is self-reported. Estimates are weighted to the noninstitutionalized U.S. population.

FIGURE 39.3

Age-Standardized Percentage of Adults Age ≥20 Years With Diabetes Using Diabetes Medication, by Type of Medication, U.S., 1997–2009. Diabetes is self reported. Data are age-standardized to the 2000 U.S. Standard Population. Estimates are (more...)

FIGURE 39.4

Age-Standardized Mean Number of Medications Among Adults Age ≥20 Years, by Diabetes Status, U.S., 2005–2010. Data are standardized to the age distribution (20–44, 45–64, ≥65 years) of the National Health Interview (more...)

TABLE 39.3

Age-Standardized Prevalence of Diabetes Comorbidities and Associated Medication Use Among Adults Age ≥20 Years, by Diabetes Status, U.S., 2005–2010.

A number of different prescription medications are typically used to control blood pressure: thiazide diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and renin inhibitors (25). The most common hypertension medications taken by diabetic patients are ACE inhibitors, followed by diuretics, beta blockers, CCBs, and ARBs.

Cholesterol Treatment

In 2005–2010, over half of adults age ≥20 years with diagnosed diabetes self-reported high cholesterol (54.1%) (Table 39.3, age-standardized; Appendix 39.2, crude estimates). The prevalence of self-reported high cholesterol was also high among adults with undiagnosed diabetes (31.0%) and prediabetes (31.4%), and lowest among adults with no diabetes (25.4%).

Control of cholesterol levels is recommended both for adults with and without diabetes (5,26). Control of cholesterol levels among adults with diabetes is associated with lower risk of CVD events (27,28,29). Almost half of adults with diabetes (45.1%) used some type of cholesterol-lowering medication (Table 39.3, age-standardized; Appendix 39.2, crude estimates). Similar to hypertension medications, the prevalence of use was lowest among adults with no diabetes (9.8%), followed by prediabetes (16.7%), and undiagnosed diabetes (21.1%). Statins were the most commonly used cholesterol-lowering medication regardless of diabetes status.

Other Prescribed Medications

In addition to medications for hypertension and high cholesterol, adults with diagnosed diabetes might also take medications related to the central nervous system; respiratory agents; gastrointestinal agents; hormones; and psychotherapeutic medications, including those for depression (see the detailed list of medications from the NHANES 2005–2010 in Appendix 39.1) (Table 39.3, age-standardized; Appendix 39.2 crude estimates). In general, the proportion of adults taking these medications in 2005–2010 was highest among those with diagnosed diabetes. Many conditions associated with these medications occur at a higher prevalence among adults with diabetes compared to the general population. For example, thyroid dysfunction commonly occurs in patients with type 1 diabetes, as autoimmune disease in one endocrine organ increases the predisposition for other autoimmune endocrine disorders. The prevalence of hypothyroidism among people with diabetes was 10% compared to 6.6% among the general population (30).

The relationship between diabetes and depression is complex, with some studies showing that diabetes may lead to depression and other studies showing that depression may lead to diabetes (18,31,32,33). The association of diabetes and depression is described in Chapter 33 Psychiatric and Psychosocial Issues Among Individuals Living With Diabetes. Regardless of the direction of causality, the age-standardized prevalence of antidepressant use in 2005–2010 was 19.0% or almost 1 in 5 adults with diabetes (Table 39.3, age-standardized; Appendix 39.2, crude estimates). This was higher than the prevalence for adults with undiagnosed diabetes (8.6%), prediabetes (9.6%), and no diabetes (11.6%).

TABLE 39.4

Prevalence of Low-Dose Aspirin Usage Among Adults Age ≥40 Years With Diagnosed Diabetes, U.S., 2012.

Prophylactic Aspirin Use

The use of prophylactic aspirin to prevent CVD among individuals with diabetes is recommended for individuals at higher risk of CVD, defined as being age ≥40 years or with additional risk factors (5,6). However, potential benefits of primary or secondary CVD reduction must also be balanced by potential risks, such as bleeding and gastrointestinal symptoms (34,35).

Almost two-thirds of adults age ≥40 years with diagnosed diabetes reported being medically advised to take low-dose aspirin as a prophylactic for CVD (61.3%) (Table 39.4). Adults with diagnosed diabetes who reported being advised to take aspirin tended to be age ≥75 years, non-Hispanic white, had longer duration of diabetes, and had a history of CVD. However, only 52.2% of adults age ≥40 years with diagnosed diabetes who received this advice reported currently following it. Adults with diabetes and a history of CVD were most likely to report currently taking aspirin after being advised to (76.2%). There was a small percentage of adults age ≥40 years with diagnosed diabetes who were not advised to take a low dose of aspirin who report taking it on their own (10.8%). This was somewhat more common among individuals age ≥65 years, men, non-Hispanic whites, high school graduates, and those with diabetes duration ≥10 years.

Self-Care Practices

Diabetes self-care practices are important for preventing diabetes complications by improving glycemic control, increasing awareness and knowledge of the complication, and identifying early symptoms (36,37). One of the first studies to look specifically at these questions in the United States found that few adults with diabetes in 1989 attended a diabetes education class (35%), reported having their eyes checked (49%), or monitored their glucose daily (39.5% among adults type 1 diabetes and 5.3% among adults with type 2 diabetes and not taking insulin) (38). Estimates of diabetes self-care practices are derived from the BRFSS 2010. These practices include diabetes education, self-monitoring of glucose levels, receiving a foot exam by a health professional, self-foot exams, dilated eye exam, annual influenza vaccine, and ever receiving the pneumococcal vaccine (Table 39.5) (39). More than half of adults with diagnosed diabetes report ever taking a course or class in diabetes self-management (57.4%). In 2010, the majority of adults with diagnosed diabetes reported receiving a dilated eye exam in the last year (62.8%), daily self-monitoring for blood glucose (63.6%), and receiving a foot exam by a health care professional in the last year (67.5%). Half of adults with diagnosed diabetes reported receiving an annual influenza vaccination (50.1%), but only 42% reported ever receiving the pneumococcal vaccine.

Diabetes duration likely impacts diabetes self-care practices (Table 39.6) (39). In 2010, adults who reported diabetes duration of ≥10 years were more likely to have completed some type of diabetes education (61.7%), whereas only half of adults with diabetes <10 years reported completing diabetes education (50.0%). Adults who reported diabetes duration of ≥10 years were more likely to report daily (69.7%) and weekly (86.2%) self-foot exams compared to adults with diabetes duration <10 years (63.0% daily and 79.2% weekly). Self-monitoring of glucose is considered standard established practice for patients with type 1 diabetes and recommended for patients with type 2 diabetes (40,41,42). Self-monitoring of glucose was more common among adults with longer duration of diabetes (72.3% for duration ≥10 years vs. 57.3% for duration <10 years) (Table 39.6). Analyses of the BRFSS 2006 found that self-monitoring of glucose was lower among men, those with less than a high school education, those with no health insurance coverage, report of taking no medication or oral medication only, having two or fewer doctor visits annually, and not attending a diabetes education course. Self-monitoring of glucose also differs by state. During 2006, the state-specific rates of self-monitoring of glucose among adults with diabetes ranged from 47.1% to 78.2% (43).

Trends in Self-Care Practices

Overall, the percentage of adults with diabetes who reported self-care practices of glucose monitoring and received a foot exam from a health care professional increased from 2000 to 2010 based on the BRFSS (Figure 39.5) (39). For example, the percentage of adults who reported daily self-monitoring of glucose increased from 48.4% in 2000 to 63.6% in 2010. Over the same period, the prevalence of receiving a foot exam by a health care professional within the last year also increased (61.3% to 67.5%). However, other self-care practices, such as annual dilated eye exams, ever attending a diabetes self-management class, annual visits to the doctor, and daily self-exam of feet, remained relatively stable from 2000 to 2010 (Figure 39.5) (39). The 2014 American Diabetes Association Standards of Care recommend an annual eye exam only for individuals with type 1 diabetes and for individuals with type 2 diabetes with retinopathy (5).

TABLE 39.5

Prevalence of Preventive Care Practices Among Adults Age ≥18 Years With Diagnosed Diabetes, U.S., 2010.

Barriers to Self-Care

Many barriers to diabetes self-care have been identified, including caring for young children, dependent adults, and/or workplace responsibilities. The Translating Research into Action for Diabetes (TRIAD) is a national, multicenter prospective study that provides useful information about effective treatments and better care for people with diabetes in managed care settings (44). Researchers for the TRIAD study asked study participants about these competing demands and examined how they affected diabetes care (45). Participants were grouped by whether they had other caregiving responsibilities (i.e., young children or dependent adults) or workplace responsibilities, had both, or had neither. Among women, those who had any caregiving responsibilities with or without employment responsibilities had higher A1c levels (average A1c, 8.2% [66 mmol/mol]) than women with no caregiving responsibilities (average A1c, 7.9% [63 mmol/mol]). Among men, any additional demands as a caregiver were associated with higher A1c levels (average A1c, 8.0%–8.3% [64–67 mmol/mol]) compared to those with no additional demands as a caregiver (average A1c, 7.8% [62 mmol/mol]). There was no significant association of additional demands with blood pressure or cholesterol levels. In general, having both caregiving and employment responsibilities was associated with lower levels of diabetes self-management. An additional aspect of barriers to diabetes self-care practices is the residential or neighborhood environment. A study of TRIAD participants found that neighborhoods where the participants perceived more problems, as defined by higher crime and less access to exercise facilities and supermarkets, were more likely to be associated with higher blood pressure and current smoking (46).

TABLE 39.6

Prevalence of Self-Care Practices Among Adults Age ≥18 Years, by Diabetes Duration, U.S., 2010.

FIGURE 39.5

Self-Care Practices Among Adults Age ≥18 Years With Diagnosed Diabetes, U.S., 2000–2010. Diabetes is self-reported. Data are age-standardized to the 2000 U.S. Standard Population. Estimates are weighted to the non-institutionalized U.S. (more...)

National surveys of adults with diabetes may not always capture differences in diabetes care practices. The quality of diabetes care may also differ by type of health care organization (47,48,49). In addition, socioeconomic disparities are associated with diabetes self-care activities. For 44,181 patients with diabetes in managed care, TRIAD investigators found that lower education levels were associated with being a current smoker, getting less regular exercise, and being less likely to engage in health-seeking behavior. No significant differences by educational level for foot exams or daily self-blood glucose monitoring were observed (50).

An analysis of the NHANES 2007–2008 examined the proportion of adults with diabetes, defined by either self-reported diagnosis or by A1c ≥6.5% (≥48 mmol/mol), who were asked whether they received medical advice to control or lose weight, exercise, or reduce calories from fats. One-third of adults with diabetes reported not receiving any advice on diet, exercise or weight management (51). The study also found differences in advice received according to body mass index (BMI). For example, 33.5% of adults with diabetes and a BMI in the highest quartile reported receiving advice to control weight compared to 29.1% of adults with BMI in the lowest quartile. Those who did receive advice on how to control or lose weight, exercise, or reduce calories from fat, were 4–8 times more likely to report practicing these behaviors compared to those who did not receive this advice (51).

Pancreas and Islet Cell Transplants

Pancreas transplants are sometimes indicated for individuals who have type 1 diabetes and in rare cases for individuals with type 2 diabetes. No data are available on the intensity of multiple daily insulin injections for individuals prior to considering a pancreas transplant. The overall goal of pancreas transplants is to restore normoglycemia by replacing part of the lost beta cell mass. A pancreatic transplant involves considerable risk, since it requires immunosuppression medications and can be rejected by the recipient (57). This procedure is primarily indicated for individuals with type 1 diabetes whose beta cells have been permanently destroyed (58). The pancreas in those with type 1 diabetes no longer produces insulin, whereas in people with type 2 diabetes, insulin production by the pancreas may still be possible. When successful, pancreatic transplants often mean that the patients no longer need daily insulin treatment.

In the United States, the rate of pancreas transplants has increased from fewer than 200 per year in the 1970s and 1980s to more than 1,200 in 2009. The majority of patients who underwent pancreas transplant were age 30–59 years, were white, and had type 1 diabetes (Table 39.7) (57). Data on pancreatic transplants are reported to the International Pancreatic Transplant Registry, which is maintained by the University of Arizona (57). There are three types of pancreatic transplants: simultaneous pancreas-kidney transplant, pancreas after kidney transplant (PAK), and pancreas transplant alone (PTA). From 2004 to 2008, more than 90% of pancreas transplant recipients had type 1 diabetes. The majority of individuals having a transplant had duration of diabetes 20–39 years, followed by individuals with duration <20 years, and those with duration 40–59 years. The characteristics of individuals who have a pancreatic transplant differ by the type of transplant, with significantly more whites than nonwhites undergoing PAK or PTA transplants (57,59).

TABLE 39.7

Selected Characteristics of Patients Who Underwent a Primary Pancreas Transplant Using a Deceased Donor, 2004–2008.

Pancreatic islet cell transplants are another type of transplant option for individuals with type 1 diabetes. During the procedure, islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person. As of 2013, the procedures were still considered experimental by the FDA and performed at hospitals receiving approval from the FDA (60,61,62). Pancreatic islet cell transplants are tracked through the Collaborative Islet Transplant Registry. There were 571 transplants from 1999 to 2009 (60).

Bariatric Surgery to Treat Diabetes

Bariatric surgery may be appropriate in some cases to treat type 2 diabetes (63,64,65). Clinical trials have found remission of type 2 diabetes among morbidly obese patients with type 2 diabetes who underwent bariatric surgery (66,67,68). Less is known on the effectiveness of bariatric surgery to treat diabetes among those who are nonmorbidly obese (69,70). How common this procedure is among obese U.S. residents with diabetes is unknown. Overall in 2002–2004, it was estimated that more than 60,000 bariatric procedures were performed among adults age 18–44 years and more than 40,000 among those age 45–64 years (Table 39.8). Among obese adults with diagnosed diabetes, there were over 20,000 procedures performed from 2002–2004. Bariatric procedures may be performed in inpatient or outpatient settings. These estimates include only inpatient procedures based on the National Hospital Discharge Survey, and the total number of bariatric procedures performed is likely to be greater than these estimates (71,72).

TABLE 39.8

Number of Obese People Age 18–64 Years Who Had Bariatric Surgery, by Diagnosed Diabetes and Age Group, 2002–2004.

List of Abbreviations

A1c

glycosylated hemoglobin

ACE

angiotensin-converting enzyme

ARB

angiotensin II receptor blocker

BMI

body mass index

BRFSS

Behavioral Risk Factor Surveillance System

CCB

calcium channel blocker

CVD

cardiovascular disease

DPP-4

dipeptidyl peptidase-4

FDA

Food and Drug Administration

NHANES

National Health and Nutrition Examination Survey

NHIS

National Health Interview Survey

PAK

pancreas after kidney transplant

PTA

pancreas transplant alone

TRIAD

Translating Research into Action for Diabetes study

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Appendices

APPENDIX 39.1. Classes and Subgroups of Medications, NHANES, 2005–2010

APPENDIX 39.2. Crude Prevalence of Diabetes Comorbidities and Associated Medication Use Among Adults Age ≥20 Years, by Diabetes Status, U.S., 2005–2010

CONVERSIONS

Conversions for A1c values are provided in Diabetes in America Appendix 1 Conversions.

DUALITY OF INTEREST

Dr. Saydah reported no conflicts of interest.

ACKNOWLEDGMENTS/FUNDING The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The author thanks Dr. Andy Menke for his assistance with the data analyses for the chapter and the editors for their thoughtful and helpful comments.