Roman mosaic of the Four Seasons from the House of Bacchus in Complutum
(Alcalá de Henares, Madrid, Spain). Late 4th century A.D.
Progress Toward Diabetic Treatment Goals
Source: Diabetes Patients Make Significant Gains in Disease Control; Still, Nearly Half Fail to Reach ADA Treatment Goals
According to the Quest Diagnostics Health Trends Report on Diabetes,
presented on 23 June 2007 at the ADA Annual Scientific Conference (posters # 21-LB and 22-LB), Americans being treated for diabetes improved control of their disease over the last six years, by 44.4%.
As of December, 2006, more than half (54.6 percent) had reached treatment goals for glycemic control, established by the American Diabetes Association (ADA), compared to 37.8 percent in 2001. This finding is a Despite these overall gains, hemoglobin A1c (HbA1c or A1c) values have plateaued since 2004 with 45 percent of patients in 2006 failing to reach treatment targets of HbA1c levels less than seven percent.
Seasonality
This excerpt from the article address seasonality of compliance:
A companion analysis of HbA1c tests revealed a significant seasonal variation in blood glucose control with HbA1c levels peaking in the winter (January-March) and falling in the summer (July-October.) These seasonal differences depended on patient age and level of A1c control, but were most apparent in the elderly (greater than or equal to 80) and those with the highest levels of HbA1c (greater than or equal to 9 percent).
Commentary
While I am uncomfortable presenting an issue based exclusively on a press release from a company intimately involved in accumulating the data, I am struck by the seasonal variation in results, a trend rarely considered as a factor in patient compliance.
This excerpt touches on the implications of the findings:
“The HbA1c plateau mirrors the clinical progression of the disease and treatment patterns,” said study co-author Richard W. Furlanetto, M. D. Ph.D., medical director, Endocrinology, Quest Diagnostics, Nichols Institute. “The newly diagnosed patient tends to be diligent and first-year treatment tends to be aggressive, so we often see relatively large improvements in blood sugar control and HbA1c levels. In subsequent years the diabetes itself worsens and the therapy gets less effective. Also, as blood sugar control improves, the risk of hypoglycemia or low blood sugar, increases and this limits therapy. Finally, over time patients may become less diligent in following their treatment plan. It is in these post-diagnosis years that we must stress patient monitoring and treatment compliance,” Furlanetto continued.
The seasonality shifts are among the most striking finding in the data, authors said, and may allow physicians to exert more control over testing and treatment schedules. According to study authors, serial HbA1c levels should be obtained in late spring and autumn to minimize the impact of seasonal fluctuations on the interpretation of HbA1c levels.
Life course and seasonality may be as important in the context of adherence as they are in chronic disease. Certainly, this could be a rewarding focus for future research.
Footnotes
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