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U.S. Diabetes Control Dangerously Poor

2/3 of Patients Don't Meet Glucose Control Targets
WebMD Health News

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:

1. Mississippi
2. Illinois
3. Utah
5. Alabama
6. Louisiana
7. New York
8. Pennsylvania
9. Arkansas
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.

"What's A1c?"

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.

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