Blood glucose levels and glycaemic burden in 76, 341 patients attending primary care: Bittersweet findings from a 9-year cohort study. (May 2017)

• Record Type: Journal Article
• Authors: Carrington, Melinda J.; Cohen, Neale; Wiley, Joshua F.
• Is Part Of: Diabetes research and clinical practice. Volume 127(2017)
• Page Start: 89
• Page End: 96
• Publication Date: 2017-05
• Subjects: Diabetes -- Primary care management -- Glycaemic control -- Glycaemic burden -- Secular trends -- HbA1C; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.02.030
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Mean glycaemic levels have dropped over nearly a decade in the primary care setting. Around half or more of treated patients still do not attain HbA1C levels of <7%. Patients spend extended time with HbA1C levels >7% without treatment modification. Real world national primary care data have never been analysed on this magnitude. Abstract: Aims: Diabetes care is principally applied in the primary care setting whereby we examined trends in glycaemic levels and goals and estimated avoidable glycaemic burden. Methods: We retrieved glycated haemoglobin (HbA1C ) results and glucose-lowering prescription records from a patient-based medical database during 2005–2013. There were 275, 480 available HbA1C measurements from 76, 341 individuals managed by 960 general practitioners from 321 clinics across Australia. Change in mean levels and glycaemic control over time were assessed according to sex, age and glucose-lowering therapy. The time that HbA1C levels exceeded 7% (53 mmol/mol) in untreated ( n = 4888), non-insulin ( n = 11, 534) and insulin treated ( n = 4049) patients was calculated as area under the curve (AUC) and months above threshold. Results: Average age of patients was 62.1 ± 15.1 years (47.1% women). HbA1C levels decreased from 7.1% (54 mmol/mol) in 2005 to 6.6% (49 mmol/mol) in 2013 and the proportion of patients who achieved a HbA1C target of <7% improved by 16% in men (53–69%) and 21% in women (55–76%). HbA1C levels decreased with advancing age in men and increased with insulin treatment; correspondingly, HbA1C goal attainment increased and decreased, respectively. Avoidable glycaemic burden was 9.3 ± 17.7 months in untreated, 16.2 ± 25.2 months in non-insulin, and 26.8 ± 34.6 months in insulin-treated patients. Conclusions: Amid considerable improvements, many treated patients still do not attain HbA1C levels ≤7% and time spent above this threshold was delayed. Earlier and more vigorously intensified management may reduce lengthy periods of uncontrolled hyperglycaemia in primary care.