March 2008: Volume 34, Number 3
Report Card: Diabetics’ Glycemic Control is Improving
A majority of U.S. diabetic patients have achieved acceptable glycemic control, defined as glycohemglobin (HbA1c ) levels < 7%, according to a recent report (Diabetes Care 2008; 1: 102–104). The researchers attributed the better rate of glycemic control to concerted efforts of clinicians and professional organizations toward achieving this goal.
A study team from the CDC and the University of Missouri School of Medicine in Columbia found that among 1,334 diabetic participants in the National Health and Nutrition Examination Survey (NHANES) 2003–2004, 56.8% had adequate glycemic control, compared with just 37.0% of diabetic NHANES 1999–2000 participants. Compared with participants from NHANES 1999–2000, the adjusted prevalence ratios for having a concentration of HbA1c <7% were 1.32 (95% CI, 0.98–1.79) for participants from NHANES 2001–2002 and 1.46 (95% CI, 1.08–1.97) for participants from NHANES 2003–2004.
Adjustment for age, sex, ethnicity, educational and smoking status, hypertension, concentration of total cholesterol, body mass index, waist circumference, treatment, and duration of diabetes in logistic regression had little effect on these figures.
While overall glycemic control rates improved and were similar in men and women for the entire 6-year period, ethnic disparities remain. White participants had better glycemic control than did African American or Mexican counterparts for the entire study period. Improvements in glycohemoglobin were steadier among whites than among African Americans and Mexican Americans, among whom increased rates of glycemic control occurred mostly before 2003.
Healthcare professionals and organizations should not rest upon learning of the apparent success related to glycemic control. “As welcome as the recent favorable trends in glycemic control are, additional efforts are needed to help the ~40% of patients with diabetes who do not have adequate glycemic control,” the researchers wrote.