Improvement in glycemic control over 11 years in patients monitored for diabetes in one county
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Lone G.M. Jørgensen
Abstract
Background: Hemoglobin A1c (HbA1c) has been used in controlled trials for the last 10years but has never been evaluated in clinical practice as an effective parameter for clinical outcome. We investigated the trend for glycemic control over 11years in one county of 350,000 citizens.
Methods: We studied 226,382 HbA1c-DCCT-aligned from 39,455 patients in whom routine monitoring for diabetes was initiated in 1993, 1996, or 2001. The trend in glycemic control was investigated in groups by probit plots, and in individual patients by target plots.
Results: From 1993 to 2001, the number of HbA1c measurements increased three-fold. The number of new monitoring series increased from 0.22% to 0.27% of the county population, and the number of patients monitored using HbA1c as a proxy for diabetes increased from 0.5% to 1.5%. A proportional reduction in high HbA1c concentrations of 5% was identified in the 1993 group, compared to 15% in the 1996 group, and 20% in the 2001 group. The percentage of patients with diabetic first HbA1c experiencing normalization increased from 8% to 30% for males and from 9% to 24% for females (1993–2001). The percentage of HbA1c concentrations that were not normalized decreased from 78% to 53% for males and from 83% to 59% for females (1993–2001). The median HbA1c at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p<10−5). The number of normal first HbA1c results in monitoring series increased from 7% to 17% for males and from 8% to 22% for females. Up to 10% of subjects developed diabetic concentrations during monitoring.
Conclusion: On average, patients with diabetic first HbA1c concentrations (≥6.62%) showed an improvement in glycemic control from 5% in 1993 to 20% in 2001. High concentrations were easiest to reduce. In patients with originally diabetic HbA1c levels, 66% on average showed improved glycemic control in the 2001 series compared to 50% in the 1993 series. An average of 6% (1993) vs. 9% (2001) with originally normal HbA1c levels showed an upward trend inHbA1c levels. Median HbA1c at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p<10−5). The incidence of new cases was constant.
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©2006 by Walter de Gruyter Berlin New York
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- Erythrocyte membrane acetylcholinesterase activity in subjects with MTHFR 677C→T genotype
- Plasma levels of tumor M2-pyruvate kinase should not be used as a tumor marker for hematological malignancies and solid tumors
- APO A-V–1131T→C polymorphism frequency and its association with morbidity in a Brazilian elderly population
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