In the Journals

Nearly 1 in 7 patients with diabetes have poor glycemic control

About one in seven patients with diabetes had poor glycemic control between 2007 and 2014 despite an increase in the frequency of self-reported testing and patient awareness of hemoglobin A1c, according to data published in JAMA.

“In 2014, an estimated 30.3 million people (9.4%) in the United States had diabetes. Improving glycemic control reduces the risk of diabetes-related vascular complications,” Saeid Shahraz, MD, PhD, from Heller School of Social Policy and Management at Brandeis University, and colleagues wrote. “Studies have shown improvement in glycemic control in the United States from 1998 through 2010, as measured by hemoglobin A1c.”

Researchers examined trends in glycemic control and patient awareness of HbA1c test results and targets using data from the National Health and Nutrition Examination Survey between 2007 and 2014. They assessed 2,908 participants with diabetes aged 20 years and older to determine the proportion with an HbA1c level less than 7% (good control), less than 8% (moderate control) and higher than 9% (poor control). They also measured how many participants reported having undergone HbA1c testing in the previous year and who were aware of their HbA1c result and their target HbA1c level.

Analysis showed that nearly one in seven participants had poor glycemic control throughout the study period even though the frequency of self-reported HbA1c testing and patient awareness of HbA1c result and patient-specific targets increased. Median HbA1c level was 6.9% in 2007 to 2008 and 6.95% in 2013 to 2014. Overall, there was no change in glycemic control between 2007 to 2008 and 2013 to 2014. A higher proportion of patients with diabetes reported having an HbA1c test in the previous year over time, from 55.1% (95% CI, 49.69-60.5) in 2007-2008 to 77.78% (95% CI, 75.07-80.48) in 2013-2014. Analysis of subgroups of age, race and sex showed a similar change.

In 2007 to 2008, 52.32% (95% CI, 47.63-57) of patients were aware of their HbA1c result in the previous year, and this proportion rose to 74.31% (95% CI, 69.63%-78.99%) in the 2013-2014 survey. This change was statistically significant in all subgroups except for in patients aged 20 to 44 years. The number of participants who were aware of the clinician-set target HbA1c level rose from 2007-2008 (74.07%) to 2013-2014 (89.7%). This change was also statistically significant in all subgroups except in those aged 20 to 44 years.

“The improvement in glycemic control between 1998 and 2010 among patients with diabetes appears to have plateaued during 2007-2014,” Shahraz and colleagues wrote. “Individualization of the target HbA1c level may explain the improvement in HbA1c testing and awareness of HbA1c targets over time in all subgroups except for patients younger than 45 years. Therefore, focusing attention on this subgroup may be important especially because they would benefit most from treatment.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.

About one in seven patients with diabetes had poor glycemic control between 2007 and 2014 despite an increase in the frequency of self-reported testing and patient awareness of hemoglobin A1c, according to data published in JAMA.

“In 2014, an estimated 30.3 million people (9.4%) in the United States had diabetes. Improving glycemic control reduces the risk of diabetes-related vascular complications,” Saeid Shahraz, MD, PhD, from Heller School of Social Policy and Management at Brandeis University, and colleagues wrote. “Studies have shown improvement in glycemic control in the United States from 1998 through 2010, as measured by hemoglobin A1c.”

Researchers examined trends in glycemic control and patient awareness of HbA1c test results and targets using data from the National Health and Nutrition Examination Survey between 2007 and 2014. They assessed 2,908 participants with diabetes aged 20 years and older to determine the proportion with an HbA1c level less than 7% (good control), less than 8% (moderate control) and higher than 9% (poor control). They also measured how many participants reported having undergone HbA1c testing in the previous year and who were aware of their HbA1c result and their target HbA1c level.

Analysis showed that nearly one in seven participants had poor glycemic control throughout the study period even though the frequency of self-reported HbA1c testing and patient awareness of HbA1c result and patient-specific targets increased. Median HbA1c level was 6.9% in 2007 to 2008 and 6.95% in 2013 to 2014. Overall, there was no change in glycemic control between 2007 to 2008 and 2013 to 2014. A higher proportion of patients with diabetes reported having an HbA1c test in the previous year over time, from 55.1% (95% CI, 49.69-60.5) in 2007-2008 to 77.78% (95% CI, 75.07-80.48) in 2013-2014. Analysis of subgroups of age, race and sex showed a similar change.

In 2007 to 2008, 52.32% (95% CI, 47.63-57) of patients were aware of their HbA1c result in the previous year, and this proportion rose to 74.31% (95% CI, 69.63%-78.99%) in the 2013-2014 survey. This change was statistically significant in all subgroups except for in patients aged 20 to 44 years. The number of participants who were aware of the clinician-set target HbA1c level rose from 2007-2008 (74.07%) to 2013-2014 (89.7%). This change was also statistically significant in all subgroups except in those aged 20 to 44 years.

“The improvement in glycemic control between 1998 and 2010 among patients with diabetes appears to have plateaued during 2007-2014,” Shahraz and colleagues wrote. “Individualization of the target HbA1c level may explain the improvement in HbA1c testing and awareness of HbA1c targets over time in all subgroups except for patients younger than 45 years. Therefore, focusing attention on this subgroup may be important especially because they would benefit most from treatment.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.