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Income Level Affects Treatment of Hyperglycemia

Posted: Wednesday, August 05, 2009

People with diabetes who live in less affluent neighborhoods are more likely to experience delays in treatment for hyperglycemia, according to a study.

However, the researchers found, neighborhood income was only one factor in determining how quickly appropriate care was received.

People who were less adherent to medication, had A1c levels (a measure of how well blood glucose is controlled over time) lower than 9%, who had higher prescription drug copayments and who had not been to a doctor recently were also more likely to experience delays in receiving care for sustained hyperglycemia (high blood sugar levels), the study found.

"Findings highlight that no one person or thing is to blame when care quality falls short," the researchers concluded. "Instead, receipt of quality care results from a complex system of factors. Although the decision to intensify diabetic medication is one usually associated with physicians, to be effective, interventions targeting improvements in pharmacological management should consider a broad array of factors. These include the financial barriers patients may face, the importance of access to routine visits, and possible psychological barriers to appropriate care."

Hyperglycemia was measured using the A1c test, which looks at average blood glucose levels over a 2-3 month period. A person without diabetes would measure roughly 5% on the A1c test. The American Diabetes Association recommends that the goal for most people with diabetes be to keep A1c levels at or below 7%. The higher the A1c level, the higher the risk for diabetes-related complications. Sustained hyperglycemia greatly increases the risk for diabetes-related complications, such as nerve damage, amputations, blindness and stroke.

The study, led by researchers at the Henry Ford Health System, Center for Health Services Research in Detroit, found that 41% of people with sustained hyperglycemia failed to get appropriate care within six months; 25% failed to get care within a year; and 11% failed to get appropriate care for as much as two years. Once blood glucose levels exceeded 9% on the A1c test, however, patients were more likely to receive treatment, the study showed.

Source: Diabetes In Control: Diabetes Care, Aug. 2009