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Half of Diabetic Patients Not Reaching HbA1c Target

Posted: Thursday, July 26, 2007

Despite significant gains in disease control over the last 6 years, nearly half of patients with diabetes failed to reach national treatment goals in 2006.

An analysis of 22.7 million hemoglobin A1c tests performed on 4.8 million patients with diabetes mellitus at Quest Labs revealed that as of December 2006, 55% of patients had reached the American Diabetes Association (ADA) treatment target of hemoglobin A1c levels less than 7%. This compares with 38% of patients in 2001.

Despite these overall gains, the decline in A1c values has slowed since 2003, leaving 45% of Americans with diabetes short of ADA targets in 2006. As this study only included those patients getting A1c tests regularly at Quest Labs, it is very likely that those patients not getting regular A1c tests would bring the numbers higher.

“For this 45%, we are going to need new approaches to control their diabetes,” coauthor Dr. Richard W. Furlanetto said at a press briefing. “We'll need new medications, certainly, but I think we'll need intensive education for these people and new ways of allowing them to live with their disease.”

Roughly 28% of patients with type 1 diabetes reached an A1c level below 7% in 2001, compared with 35% of patients in 2006. In contrast, 45% and 57% of patients with type 2 diabetes reached the target over the same time period, said Dr. Furlanetto, a pediatric endocrinologist and medical director of endocrinology at Quest Diagnostics Nichols Institute, Chantilly, Va.

In patients with type 2 diabetes, the overall mean A1c values declined from 7.6% in 2001 to 7.3% in 2003, but then slowed significantly and stabilized at 7.2% in 2006, according to the analysis of data from the Quest Diagnostics Informatics Data Warehouse, a large private reference laboratory database.

The authors suggest that this HbA1c plateau mirrors the clinical progression of the disease as well as treatment patterns. Longitudinal analysis indicates that A1c values for individual patients decreased in the first 1–2 years, and then trended slowly upward. This could be a result of aggressive therapy and strict compliance in the early years, followed by worsening of the disease, which limits therapy, and less diligent treatment compliance, Dr. Furlanetto said.

Although the number of tests reported in the study is more than 50 times that of other published reports on diabetes health, reporters asked if the findings apply to the average patient, given that the sample represents a fraction of the roughly 21 million Americans with diabetes.

Source: Diabetes In Control: Presented at the 67th ADA Scientific Sessions in Chicago