What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Diabetes (n=3464). Primary outcome: Self-reported knowledge of recent HbA1c level (95% CI 55.4%-61.2%).

May 8, 2026Open Access

Reported Knowledge of Recent HbA1c, Blood Pressure, and LDL-cholesterol Levels and Goals Among US Adults with Diabetes—National Health and Nutrition Examination Survey 2011–2020

Key Result

Among US adults with diabetes, only 58.3%, 68.3%, and 18.0% reported knowing their recent HbA1c, blood pressure, and LDL-cholesterol levels, respectively.

Key Points

The aim is to determine the proportions of US adults with diabetes who report knowing their HbA1c, blood pressure, and LDL-cholesterol levels and goals.
Cross-sectional analysis using data from NHANES spanning 2011–2020.
Participants included US adults with self-reported diabetes.
Age-sex-adjusted Poisson regression models were employed to assess the association of sociodemographic characteristics with knowledge outcomes.
58.3% reported knowing their recent HbA1c levels (95% CI: 55.4%-61.2%).
68.3% reported knowing their blood pressure levels (95% CI: 65.7%-70.7%).
Only 18.0% reported knowing their LDL-cholesterol levels (95% CI: 16.3%-19.8%).

Study Design

Type

Cross-Sectional (n=3,464)

Structured PICO

Population

3,464 US adults with self-reported diabetes from the National Health and Nutrition Examination Surveys (NHANES) 2011–2020

Outcome

Self-report of knowing HbA1c, BP, and LDL-cholesterol levels and goalspatient reported

A low percentage of US adults with diabetes report knowing their HbA1c, BP, or LDL-cholesterol levels and goals, indicating a need for interventions to increase risk factor awareness.

Limitations

Relatively small sample size in certain subgroups, particularly in the fasting subsample
Relied on self-reported responses to determine awareness rather than numeric accuracy
Could not determine if participants were actually told their risk factor levels and goals by clinicians

Abstract

Abstract Background Guidelines recommend adults with diabetes should know their hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL)-cholesterol levels and goals. Objective Determine the proportions of US adults with diabetes who report knowing their HbA1c, BP, and LDL-cholesterol levels and goals as recommended by their doctor or healthcare provider. Design A cross-sectional analysis of the US adults with self-reported diabetes from 2011–2020 in the National Health and Nutrition Examination Surveys (NHANES). Participants US adults in NHANES with self-reported diabetes. Main Measures Sociodemographic characteristics including age, sex, race and ethnicity, education, and health insurance coverage were assessed using standardized questionnaires. The outcomes were self-report of knowing HbA1c, BP, and LDL-cholesterol levels and goals. Age-sex-adjusted Poisson regression models with robust variance estimation were used to estimate associations of participant characteristics with each of these outcomes. Results Among US adults with diabetes included in the analysis ( N = 3,464), 58.3% (95% CI: 55.4%-61.2%), 68.3% (95% CI: 65.7%-70.7%) and 18.0% (95% CI: 16.3%-19.8%) reported knowing their recent HbA1c, BP, and LDL-cholesterol levels, respectively, and 53.4% (95% CI: 50.5%-56.2%), 39.7% (95% CI: 37.2%-42.3%), and 13.4% (95% CI: 11.5%-15.6%) reported knowing their HbA1c, BP, and LDL-cholesterol goals, respectively. Non-Hispanic Black and Hispanic versus non-Hispanic White adults, those with less than versus at least a high school education, and those without versus with health insurance were less likely to report knowing their HbA1c, BP, or LDL-cholesterol levels and goals. Conclusion Low percentages of US adults with diabetes reported knowing their HbA1c, BP, or LDL-cholesterol levels and goals. Understanding reasons for the gaps in knowledge among US adults with diabetes may facilitate interventions to increase risk factor awareness and diabetes self-management behaviors.

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