Physical inactivity ● 38.0% were physically inactive, defined as getting less than 10 minutes a week of moderate or vigorous activity in
each physical activity category of work, leisure time, and transportation.
A1C ● 50.0% had an A1C value of 7.0% or higher Specifically: ● 22.3% had an A1C value of 7.0% to 7.9% ● 13.2% had an A1C value of 8.0% to 9.0%
● 14.6% had an A1C value higher than 9.0% ● 16.3% of adults aged 18–44 years had A1C levels of 10% or higher, compared to 12.7% of those aged 45–64 years and 4.3% of those aged 65 years or older.
High blood pressure ● 68.4% had a systolic blood pressure of 140 mmHg or higher or diastolic blood pressure of 90 mmHg or higher or were on prescription medication for their high blood pressure. High cholesterol ● 43.5% had a non-HDL level of 130 mg/dL or higher Specifically: ● 22.4% had a non-HDL level of 130 to 159 mg/dL Cardiovascular disease Prevention and management of complications of diabetes are important strategies for the promotion of health and wellness among those persons with diabetes mellitus. Cardiovascular disease (CVD) is the major cause of morbidity and mortality for Hypertension Hypertension is a significant problem among people with diabetes and is a major risk factor for cardiovascular disease. There are generally three categories of blood pressure (CDC, 2020b): 1. Normal: systolic is less than 120 mmHg; diastolic is less than 80 mmHg. 2. Prehypertension: systolic is 120 to 139 mmHg; diastolic is 80 to 89 mmHg. 3. Hypertension: systolic is 140 mmHg or higher; diastolic is 90 mmHg or higher. Persons who have elevated blood pressure should have blood pressure confirmed by using multiple readings and on separate days to diagnose hypertension. Additionally, all patients with hypertension and diabetes should monitor their blood pressure at home (American Diabetes Association, 2021a). In pregnant patients with diabetes and pre-existing hypertension, blood pressure targets of 110-135/85 mmHg are suggested (ADA, 2021a). The ADA (2021a) Standards of Medical Care in Diabetes recommends the following treatment initiatives for blood pressure control in persons with diabetes (American Diabetes Association, 2021a): ● Blood pressure should be measured at every routine clinical visit. Patients found to have elevated blood pressure (≥140/90 mmHg) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension. ● All hypertensive patients with diabetes should monitor their blood pressure at home. ● For patients with diabetes and hypertension, blood pressure targets should be individualized through a shared decision- making process that addresses cardiovascular risk, potential adverse effects of antihypertensive medications, and patient preferences. ● For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease [ASCVD] or 10-year ASCVD risk ≥15%), a blood pressure target of <130/80 mmHg may be appropriate if it can be safely attained. ● For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15%), treat to a blood pressure target of <140/90 mmHg. ● In pregnant patients with diabetes and preexisting hypertension, a blood pressure target of 110–135/85 mmHg is suggested in the interest of reducing the risk for
● 11.2% had a non-HDL level of 160 to 189 mg/dL ● 9.9% had a non-HDL level of 190 mg/dL or higher
persons who have diabetes as well as the largest contributor to both direct and indirect costs of diabetes. Research has shown that controlling individual cardiovascular risk factors helps prevent or slow CVD development in people with diabetes (ADA, 2021a). accelerated maternal hypertension and minimizing impaired fetal growth. ● For patients with blood pressure >120/80 mmHg, lifestyle intervention consists of weight loss when indicated, a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern including reducing sodium and increasing potassium intake, moderation of alcohol intake, and increased physical activity. ● Patients with confirmed office-based blood pressure ≥140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of pharmacologic therapy to achieve blood pressure goals. ● Patients with confirmed office-based blood pressure ≥160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes. ● Treatment for hypertension should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes. ACE inhibitors or angiotensin receptor blockers are recommended first-line therapy for hypertension in people with diabetes and coronary artery disease. ● Combination drug therapy is generally required to achieve blood pressure targets. However, combinations of ACE inhibitors and angiotensin receptor blockers and combinations of ACE inhibitors or angiotensin receptor blockers with direct renin inhibitors should not be used. These combinations increase the risk of hypotension, hyperkalemia, and renal impairment. ● An ACE inhibitor or angiotensin receptor blocker, at the maximum tolerated dose indicated for blood pressure treatment, is the recommended first-line treatment for hypertension in patients with diabetes and urinary albumin- to-creatinine ratio ≥300 mg/g creatinine or 30–299 mg/g creatinine. If one class is not tolerated, the other should be substituted. ● For patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic, serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored at least annually. ● Patients with hypertension who are not meeting blood pressure targets on three classes of antihypertensive medications (including a diuretic) should be considered for mineralocorticoid receptor antagonist therapy. The DASH (Dietary Approaches to Stop Hypertension) diet focuses on fruits, vegetables, whole grains, and other foods that are deemed to be heart healthy and low in fat, cholesterol, and sodium. DASH also emphasizes intake of fat-free or low-fat dairy products, fish, poultry, and nuts. The intake of red meats, sweets, added sugars, and sugar-containing beverages is reduced. DASH
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