In a study of more than 157,000 patients with type 2 diabetes, two out of three were not in control of their blood sugar, and failed to meet the new American Association of Clinical Endocrinologists (AACE) target HbA1c of ≤6.5% (see the sidebar at the bottom of the page). According to the “State of Diabetes in America” report from the AACE, there is significant room for improvement in diabetes management in every state. The report was presented at AACE’s 14th Annual Meeting and Clinical Congress in Washington, DC.

A majority (84%) of the Americans with type 2 diabetes polled as part of a national survey say that they are doing a good job of managing their diabetes by controlling their blood sugar, according to the AACE.

STRUGGLE TO CONTROL

“Despite major advances in diabetes care and the variety of tools available to help people with type 2 diabetes manage the condition, this report suggests that America’s type 2 diabetes population is struggling to control their blood sugar levels and affirms the outcomes from our recent Implementation Consensus Conference,” said Carlos R. Hamilton, Jr, MD, president of AACE. “Type 2 diabetes is of urgent concern and these findings must serve as a wake-up call for America that more needs to be done to help lower [HbA1c] levels across the country and ultimately, manage this epidemic.”

ABOUT HBA1C

The “State of Diabetes in America” report included critical information about blood sugar levels throughout the United States, as measured by HbA1c. AACE recommends an HbA1c target level of ≤6.5%. This is significant, according to an AACE news release, because every 1% increase above 6% elevates a person’s risk of serious and potentially life-threatening diabetes-related complications. Patients should have a personalized HbA1c goal, however. Reaching that goal includes meal planning, regular physical activity and medication, either monotherapy or in combination.

“The medical community needs to intervene earlier and more aggressively to control blood sugar because of the link between high HbA1c levels and diabetes-related complications,” said Jaime A. Davidson, MD, chair of the American College of Endocrinology/AACE’s recent Implementation Consensus Conference. (See Dr. Bergenstal’s editorial in the March/April 2005 issue). “We also need to encourage people with type 2 diabetes to take control of their own health by educating them about the central role they themselves play in the long-term management of their diabetes.”

GAPS IN KNOWLEDGE REVEALED

A nationwide survey carried out in conjunction with a new campaign called the “State of Diabetes in America: Striving for Better Control” showed that while almost all (98%) people diagnosed with type 2 diabetes agree that blood sugar control is important, the majority (61%) do not know what the HbA1c test is. In fact, even after being told what it is, half of all those surveyed do now know what their last HbA1c number was.

Based on the report and the survey findings, the campaign is designed to improve diabetes management in the United States by providing people with type 2 diabetes the tools to help them control blood sugar levels and giving them an easy-to-understand road map for successful diabetes management.  The key principles of the campaign center around what people with type 2 diabetes can do to get their blood sugar numbers down.

AACE is encouraging the many Americans with type 2 diabetes to join together in taking an oath to better control blood sugar levels. To learn more, direct your patients to www.stateofdiabetes.com. A free diabetes-friendly cookbook is also available.

STATE-BY-STATE RANKINGS

Table 1 is a state-by-state ranking showing the percentage of people studied who were above the HbA1c goal of 6.5%. The higher the ranking, the greater the percentage of people who were not in control of their blood sugar levels. A total of 39 states and Washington, DC, are included. Data for the Report were provided by Surveillance Data Inc (SDI). Table 2 lists states for which SDI data were not available. Hence, it is based on HEDIS Quality Comparisons data from 2003, which shows the percentage of people with diabetes who were above HbA1c of 9%. The National Committee for Quality Assurance (NCQA) provides HEDIS data, which are often used by managed care organizations to measure performance and health care quality in key disease areas, including diabetes. (In this case the higher the ranking the better quality performance – indicating fewer individuals have an HbA1c in the very poor control range of over 9%).

New HbA1c Standard of 6.5% Announced

The American College of Endocrinology’s president announced the new standard prior to the start of the American Association of Clinical Endocrinologists’ annual meeting.

By Conni Bergmann Koury, Editor-in-Chief

A new HbA1c standard of ≤6.5% for patients with type 2 diabetes was announced by the American Association of Clinical Endocrinologists (AACE).

The current president of the American College of Endocrinology, Paul Jellinger, MD, said a stronger approach is needed for treating patients with type 2 diabetes, and the disease must be diagnosed more aggressively in at-risk patients. Dr. Jellinger, professor of medicine on the voluntary faculty at the University of Miami, spoke at a media briefing before the AACE 14th Annual Meeting and Clinical Congress in Washington, DC.

He said that the new standard is a more comprehensive effort to prevent diabetes complications. The effort also includes a public health campaign called the “State of Diabetes in America: Striving for Better Control.” Both steps are results of a report that showed that two-thirds of Americans with type 2 diabetes are not in control of their disease. Most patients with diabetes in the United States had HbA1c levels above the current guideline, and 61% had no knowledge of the HbA1c test or of their own level, according to the report.

Daily blood sugar readings should be <110 mg/dL prior to breakfast and <140 mg/dL 2 hours postprandially, Dr. Jellinger said. “Blood sugar control is worsening today while blood pressure and cholesterol levels are improving.”

The physicians stressed the importance of early diagnosis of diabetes. AACE recommendations include 2-hour 75-g glucose challenge tests for all patients who have risk factors including:

• family history of diabetes

• obesity

• sedentary lifestyle

• ethnicity (African-Americans, American Indians, Asians, Pacific Islanders and Hispanic Americans are at high risk)

• gestational diabetes during pregnancy

• delivery of a larger-than-average-weight baby

• polycystic ovary syndrome

• peripheral vascular disease

• hypertension

• hypercholesterolemia

• coronary heart disease

AACE is urging physicians to bring diabetes to the forefront and stress the importance of diagnosis and management of the condition to their patients. After diagnosis, AACE is asking frontline physicians to be relentless in treating the condition as well as recommending combination therapy.

Preconference briefing. American Association of Clinical Endocrinologists 14th Annual Meeting and Clinical Congress. May 18-22, 2005. Washington, DC.