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D-5.2 Data Details

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D-5.2 Proportion of the diabetic population with an A1c value less than 7 percent

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): 
53.1 (2005–08)
Target: 
Not applicable
Target-Setting Method: 
This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
Target-Setting Method Justification: 
Given the evolution of practice standards, it is not advisable to perpetuate D- 5.2 as an objective associated with a “target” value. The optimal target proportion with A1c <7% cannot be determined at this time. In the absence of a target-setting method that can acknowledge the impact of an aging diabetic population, Healthy People 2020 should modify objective D-5.2 so that it no longer designates an increasing target level for the general population of persons with diabetes. HP 2020 should continue, however, to track the proportion of diabetic patients whose A1c is less than 7%. We consider this an “informational” function which will help evaluate national trends in the balance between control of hyperglycemia and the possible over-treatment that can contribute to hypoglycemia.
Numerator: 

Number of persons aged 18 years and over with doctor diagnosed diabetes and with HbA1c values <7%

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
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:

    • 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+
    • Health Insurance Status: 18-49, 50-59, 60-64
    • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
    • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
Caveats and Limitations: 
The definitions of good 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.

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 2015 this objective was revised from measurable with a target to informational status. Also, in 2015, the programming was revised to more explicitly exclude pregnant women from the analysis. The baseline was revised from 53.5% to 53.1%.