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D-5.1 Data Details

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D-5.1 Reduce the proportion of persons with diabetes with an A1c value greater than 9 percent
LHI

Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
National Health and Nutrition Examination Survey
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
percent (age adjusted—see Comments)
Baseline (Year): 
18.0 (2005–08)
Target: 
16.2
Target-Setting Method: 
10 percent improvement
Numerator: 

Number of persons aged 18 years and over with doctor diagnosed diabetes and with HbA1c values >9%

Denominator: 

Number of persons aged 18 years and over who report that they have ever been diagnosed with diabetes

Comparable Healthy People 2010 Objective: 
Not applicable
Questions Used to Obtain the National Baseline Data: 

    From the 2005-2008 National Health and Nutrition Examination Survey:

    [NUMERATOR AND DENOMINATOR:]

    {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

    1. Yes
    2. No
    3. Borderline
    4. Refused
    5. Don't know
Data Collection Frequency: 
Periodic
Leading Health Indicator:
Methodology Notes: 

    Persons are considered to have diagnosed diabetes if they respond ‘yes’ to ever being told by a doctor or health professional that they have diabetes or sugar diabetes. Those who respond borderline are counted as ‘no’. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Women who are pregnant at the time of the exam are also excluded.

    Age Adjustment Notes: 

    This Indicator uses Age-Adjustment Groups:

    For four-year data estimates:

    • Total: 18-49, 50-59, 60-69, 70-79, 80+
    • Sex: 18-49, 50-59, 60-69, 70-79, 80+
    • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
    • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
    • Family Income (percent poverty threshold): 18-49, 50-59, 60-69, 70-79, 80+
    • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
    • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Health Insurance Status: 18-49, 50-59, 60-64
    • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
    • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

    For two-year data estimates:

    • Total: 18-39, 40-59, 60+
    • Sex: 18-39, 40-59, 60+
    • Race/Ethnicity: 18-39, 40-59, 60+
    • Educational Attainment: 25-39, 40-59, 60+
    • Family Income (percent poverty threshold): 18-39, 40-59, 60+
    • Country of Birth: 18-39, 40-59, 60+
    • Disability Status: 20-39, 40-59, 60+
    • Health Insurance Status: 18-39, 40-59, 60-64
    • Marital Status: 20-39, 40-59, 60+
    • Veteran Status: 18-39, 40-59, 60+
    • Obesity Status: 20-39, 40-59, 60+
Caveats and Limitations: 
The definitions of poor glycemic control can vary for individuals based on factors such as age, co-morbidities, symptomatic history, or social circumstances.
Trend Issues: 
Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.

Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Different age adjustment groups are used for the two year and four year data. Two-year estimates are generally less stable and reliable than four-year estimates.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
In 2012, the original baseline was revised from 16.2% to 17.9% due to a change in programming. A cross over regression adjustment was used for the original baseline and has since been removed following the NHANES guidance for these data. The target was adjusted from 14.6% to 16.1% to reflect the revised baseline using the original target-setting method. In 2015, the programming was revised to more explicitly exclude pregnant women from the analysis. The baseline was revised from 17.9% to 18.0%. The target was adjusted from 16.1% to 16.2% following the original target-setting method.