Diabetes control worsened from 2013-2023

March 17, 2025

Mean Hemoglobin A1C in People with Diabetes

Portion of People with Diabetes with Good Blood Sugar Control

Source: Inoue, et al JAMA February 27, 2025

Researchers in JAMA used the NHANES database (National Health and Nutrition Evaluation Survey) to evaluate the overall control of diabetes in the U.S. between 2013-2023. This database includes over 4600 people with diabetes who completed surveys and had extensive blood tests. The researchers found that mean HbA1C levels and blood sugar tests (both are indications of control of diabetes) were stable from 2013-2017 and worsened from 2017-2023.

This is especially disappointing since the drugs to treat diabetes have improved substantially over this time period. Diabetes control was worst in those ages 20-44, who are predominantly covered by employer-sponsored health insurance. Worse control of diabetes increases the risk of heart attack, stroke, blindness, kidney failure and amputation. The consequences of poor diabetes control are related to how long diabetes is in poor control, so the health impacts of worse control of younger adults will have the largest impact over time.

Implications for employers:

• Employers can review programmatic efforts of their carriers and any third-party vendors to improve diabetes care.

• Adherence to (expensive) diabetes medications and testing is higher with “value-based insurance design” which charges lower or no cost sharing for diabetes medications and test supplies.

• Employers can ask their carriers for reporting on diabetes control in their populations. Segmenting the population by age could help companies better tailor their programing.

• Employers can ask their cardiometabolic vendor partners to put performance guarantees around control of diabetes.

• Here are 2023 rates of effectiveness of care from the National Committee on Quality Assurance (NCQA) for commercial PPO members, demonstrating that there is plenty of opportunity for improvement:

  • Blood pressure control <140/90: 60%

  • Blood sugar control HbA1C <8: 57%

  • Blood sugar control HbA1C <9: 65%

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Tomorrow: Prevalence of medical borrowing is high