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Nation's Blood Glucose Out of Control

Elizabeth Thompson Beckley

Despite perceptions to the contrary, a majority of the nation's type 2 diabetes patients do not have their blood glucose under control, according to a report from the American Association of Clinical Endocrinologists (AACE).

Two-thirds of Americans with type 2 diabetes, or 67%, did not meet AACE's 6.5% target for glycated hemoglobin (A1C) in 2003 and 2004, concludes the "State of Diabetes in America" report. The data were released on the opening morning of AACE's annual meeting and clinical congress, held May18–22 in Washington, D.C.

AACE launches blood glucose public awareness campaign.

A separate national survey of 501 adults with diabetes shows 84% believe they are doing a good job of controlling their blood glucose. Yet 61% did not know what an A1C test was, and 51% did not know what their last A1C number was.

The study analyzed A1C test scores, collected by Surveillance Data Inc. (SDI), of more than 157,000 people with type 2 diabetes in 39 states and Washington, D.C. For states where SDI data were not available, 2003 Health Plan Employer Data and Information Set (HEDIS) Quality Comparisons data were used. The HEDIS numbers showed that between 20.4% and 34.5% of people with diabetes had A1C levels >9% in the 10 states analyzed.

In 2002, diabetes cost about $132 billion, but 80% of that money went into treating diabetes-related complications, says Jaime A. Davidson, MD, of Medical City Dallas Hospital.

A better investment would be in diabetes control, "to treat the patient to target," says Davidson, co-chair of a joint AACE/American College of Endocrinology (ACE) panel that recently developed a consensus statement for the implementation of their diabetes care guidelines (DOC News, May 2005).

AACE and ACE recommend an A1C target level 6.5% and plasma glucose levels of <110 mg/dl before a meal and <140 mg/dl 2 hours after eating. The targets of the American Diabetes Association (ADA) are <7% A1C, 90–130 mg/dl preprandial plasma glucose, and <180 mg/dl peak postprandial plasma glucose.

"We would agree that even with our goal of 7%, not enough people are there," says Richard Kahn, PhD, ADA's chief scientific and medical officer. "We would not agree with 6.5% as the goal line. We know that normal is 4% to 6%. We also know it is extremely difficult to get to 6%. No study has ever gotten below 7% as an average in a population of people with diabetes. Our goal represents the best you can do in a clinical trial, which is the best setting you can use to accomplish something, [where] all efforts are put toward achieving the goal of therapy."

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beckley, E. T. Search for Related Content PubMed Articles by Beckley, E. T. Social Bookmarking                What's this?