title: Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999-2002: the National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  To estimate the proportion of U.S. adults with diabetes who meet American Diabetes Association (ADA) clinical practice recommendations.
  
  
  METHODS
  Using data from the 1999-2002 National Health and Nutrition Examination Survey, 998 adults aged >/=18 years with self-reported diabetes were identified. The proportion of adults with diabetes meeting ADA recommendations for HbA(1c) (A1C), HDL cholesterol, LDL cholesterol, triglycerides, blood pressure, renal function, nutrient intake, smoking, pneumococcal vaccination, and physical activity was estimated.
  
  
  RESULTS
  Among U.S. adults with diabetes in 1999-2002, 49.8% had A1C <7%; 27.4, 36.0, and 65.0% were classified as low risk for HDL cholesterol, LDL cholesterol, and triglycerides, respectively. Nearly 40% met blood pressure recommendations, 66% had normal renal function, and daily nutrient recommendations for protein, saturated fat, unsaturated fat, and fiber were met by 64.0, 48.3, 28.3, and 18.3%, respectively. Although >81% of the sample reported not smoking at the time of the exam, only 38.2% reported ever having had a pneumococcal immunization, and 28.2% reported getting the recommended level of physical activity. Race, age, duration of diabetes, and education affected achievement of ADA recommendations.
  
  
  CONCLUSIONS
  Achievement of ADA clinical practice recommendations is far from adequate in U.S. adults with diabetes.
authors.affiliation: Department of Epidemiology and Statistics, MedStar Research Institute, 6495 New Hampshire Ave., Suite 201, Hyattsville, MD 20783. helaine.e.resnick@medstar.net
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Foster
authors.forename: Joan
authors.initials: J
authors.lastname: Bardsley
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000652:urine; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000534:rehabilitation*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D017410:Practice Guidelines as Topic / Q000592:standards; D012907:Smoking / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology; D014837:Voluntary Health Agencies
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003404:Creatinine; D006442:Glycated Hemoglobin; D014280:Triglycerides