Trends in Insulin Use and Diabetes Control in the U.S.: 1988–1994 and 1999–2012

Over the past two decades, many new treatment options have been introduced for type 2 diabetes. Increasingly, there is debate regarding the effectiveness of insulin as the last-line therapy. While diabetes control has improved over the past two decades (1–3), a substantial portion of patients is still not meeting the clinical targets. To examine national trends in glycemic control by insulin and oral diabetes medication use, we conducted a cross-sectional study of 4,947 adult participants with diagnosed diabetes (all types) in the National Health and Nutrition Examination Survey (NHANES) in the 1988–1994 and 1999–2012 cycles. The NHANES surveys are cross-sectional, complex probability samples of the U.S. civilian noninstitutionalized population. All NHANES protocols were approved by an institutional review board, and informed consent was obtained from participants. Hemoglobin A1c (HbA1c …