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Defeat Diabetes Foundation

Defeat Diabetes
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Better Treatment, Goal Attainment Needed for Diabetics in Managed Care Organizations

Posted: Thursday, March 18, 2004

Management of diabetes is necessary to diminish the significant risks of cardiovascular disease (CVD) associated with this disorder. The American Diabetes Association (ADA) designed a set of guidelines for blood glucose, blood pressure (BP) and cholesterol, which diabetics should achieve. However, the degree to which they are monitored and treated for these parameters is unknown.

In a study of 7,114 patients with diabetes, Sarah Beaton, PhD, of the Lovelace Clinic Foundation, Albuquerque, New Mexico, United States, and colleagues examined the adequacy of care for diabetics in a managed care setting.

The patients, mean age 62 years, were enrolled in a managed care organization (MCO) over a 2-year period. Patients were retrospectively selected from an MCO database through identification criteria from the 2000 Health Plan Employer Data and Information Set (HEDIS).

Treatment and goal attainment rates were monitored for the CVD risk factors, A1C (glycemic index), cholesterol and BP. Blood pressure was obtained from a sub-set of 409 patients where medical charts were available for analysis.

2003 ADA guidelines were used in selecting goal levels: A1C of less than 7%, LDL and HDL cholesterol levels less than 100 mg/dL and greater than 45 mg/dL, respectively, and systolic and diastolic BP of less than 140 mm Hg and less than 80 mm Hg, respectively.

Testing for BP and A1C was fairly adequate in this population, measured at least once in 95% and 77% of patients, respectively. However, LDL cholesterol was measured at a rate of only 54%.

Medication for glycemic control was prescribed for 72% of the diabetic patients. Lipid-lowering prescriptions were used in 28% of patients, and in 65% of diabetics with an additional diagnosis of hyperlipidemia. Blood pressure medication was used in 64% of the population, and in 87% of those with hypertension.

In contrast to testing adequacy, the majority of diabetics did not attain treatment goals. Notably, elevated glycemic index was seen in 63% of the diabetic patients, 78% had high LDL cholesterol, and 63% had low HDL cholesterol. A total of 71% of diabetics did not meet the combined systolic/diastolic BP goals.

The authors note that the 2-year study length is limiting, and that a longitudinal design would best test these questions. In addition, stratification of the goal values based on degree of risk may provide better management solutions.

In conclusion, they suggest that these results "provide further evidence of the need to implement aggressive glycemic, lipid, and BP management to improve goal attainment, thereby contributing to a reduction in the burden of cardiovascular disease among patients with diabetes."