U.S. Diabetes Control Dangerously Poor
2/3 of Patients Don't Meet Glucose Control Targets
May 18, 2005 -- Two-thirds of patients with type 2 diabetes do not adequately control their blood sugar, leaving millions of U.S. patients vulnerable to the disease's complications, according to a report released Wednesday.
Experts caution that the results show a dangerous lack of attention from both doctors and the estimated 13.8 million Americans diagnosed with diabetes.
The recommendations by the American Association of Clinical Endocrinologists for managing blood sugars set a limit for a measure known as hemoglobin A1c. Experts consider the test the most important measure of a diabetic person's blood glucose control because it estimates an average blood sugar level over a two- to three-month period.
Studies have shown that the risk of complications in people with type 2 diabetes -- including nerve damage, blindness, and kidney failure -- all increase as hemoglobin A1c goes up.
But Wednesday's report, based on health records of 157,000 patients with diabetes, showed that 67% of people with type 2 diabetes have A1c scores exceeding 6.5%, a limit laid down in the group's recommendations. Not one of 39 states surveyed had more than half its diabetic population under the limit, it concludes.
The top 10 states with the worst diabetes control were:
7. New York
10. West Virginia
"I think we need to get serious," says Jaime A. Davidson, MD, a clinical associate professor of internal medicine at the University of Texas Southwestern Medical School in Dallas. "I want to tell you, none of us are doing well."
"The report, I think, is sobering. The key message to me is that this is a national problem," says Lawrence Blonde, MD, a member of the American Association of Clinical Endocrinologists board of directors.
Another study performed by the group suggests that widespread lack of awareness of the hemoglobin A1c tests may be partly to blame for the poor scores, Blonde says. Six in 10 diabetic people in an April 2004 survey were unaware of the test, while half of those who were aware of it did not know their latest score.
The national survey was financed by GlaxoSmithKline, a pharmaceutical company that makes medications used by people with type 2 diabetes. GlaxoSmithKline is a WebMD sponsor.
Paul S. Jellinger, MD, president of the American College of Endocrinology, tells WebMD that doctors should strive to make A1c a household word among diabetes patients and people at risk for the disease. "It needs to be driven home to both physicians and patients," he says.
"Patients need to ask for [the A1c test] just like they ask, 'What is my cholesterol?'" he says.
Mississippi ranked at the bottom of 39 states in the nationwide survey, with 72.8% of its diabetic adults above the 6.5% A1c target. Montana was best with 55.2% above the goal.
Of 10 states measuring percentages of people with type 2 diabetes at levels above 9%, New Hampshire scored best.