Two-thirds of patients with type 2 diabetes do not adequately control their blood sugar, leaving millions of U.S. patients vulnerable to the disease's complications, according to a report released Wednesday.
Experts caution that the results show a dangerous lack of attention from both doctors and the estimated 13.8 million Americans diagnosed with diabetes.
Guidelines issued in January recommend that persons with type 2 diabetes, previously known as adult-onset diabetes, maintain blood glucose levels of 110 mg/dL before meals and 140 mg/dL after meals.
The recommendations by the American Association of Clinical Endocrinologists for managing blood sugars set a limit for a measure known as hemoglobin A1c. Experts consider the test the most important measure of a diabetic person's blood glucose control because it estimates an average blood sugar level over a two- to three-month period.
Studies have shown that the risk of complications in people with type 2 diabetes — including nerve damage, blindness, and kidney failure — all increase as hemoglobin A1c goes up.
But Wednesday's report, based on health records of 157,000 patients with diabetes, showed that 67% of people with type 2 diabetes have A1c scores exceeding 6.5 percent, a limit laid down in the group's recommendations. Not one of 39 states surveyed had more than half its diabetic population under the limit, it concludes.
The top 10 states with the worst diabetes control were: Mississippi, Illinois, Utah, Ohio, Alabama, Louisiana, New York, Pennsylvania, Arkansas, West Virginia.
"I think we need to get serious," says Jaime A. Davidson, MD, a clinical associate professor of internal medicine at the University of Texas Southwestern Medical School in Dallas. "I want to tell you, none of us are doing well."
"The report, I think, is sobering. The key message to me is that this is a national problem," says Lawrence Blonde, MD, a member of the American Association of Clinical Endocrinologists board of directors.
"What's A1c?"
Another study performed by the group suggests that widespread lack of awareness of the hemoglobin A1c tests may be partly to blame for the poor scores, Blonde says. Six in 10 diabetic people in an April 2004 survey were unaware of the test, while half of those who were aware of it did not know their latest score.
The national survey was financed by GlaxoSmithKline, a pharmaceutical company that makes medications used by people with type 2 diabetes. GlaxoSmithKline is a WebMD sponsor.
Paul S. Jellinger, MD, president of the American College of Endocrinology, tells WebMD that doctors should strive to make A1c a household word among diabetes patients and people at risk for the disease. "It needs to be driven home to both physicians and patients," he says.
"Patients need to ask for [the A1c test] just like they ask, 'What is my cholesterol?'" he says.
Mississippi ranked at the bottom of 39 states in the nationwide survey, with 72.8% of its diabetic adults above the 6.5% A1c target. Montana was best with 55.2% above the goal.
Of 10 states measuring percentages of people with type 2 diabetes at levels above 9%, New Hampshire scored best.
Full List of States
The table below is a state-by-state ranking showing the percentage of people studied with the A1C goal of 6.5%. The higher the ranking, the greater the percentage of those who are not in control of their blood sugar levels. A total of 39 states and Washington, D.C., are included. Data for report were provided by Surveillance Data Inc. (SDI).
Rank/State/Percent
1. Mississippi 72.8
2. Illinois 72.6
3. Utah 72.4
4. Ohio 71.7
5. Alabama 71.3
5. Louisiana 71.3
6. New York 71.1
7. Pennsylvania 70.9
8. Arkansas 69.6
9. West Virginia 69.5
10. Georgia 69.3
11. New Mexico 68.6
12. Washington 68.4
13. Maryland 68.1
14. Virginia 67.7
14. Texas 67.7
15. New Jersey 67.3
15. Arizona 67.3
15. Nevada 67.3
16. Colorado 67.1
17. Kansas 67.0
18. Kentucky 66.8
18. Washington, D.C. 66.8
19. Delaware 66.4
19. Indiana 66.4
20. South Carolina 66.3
21. Missouri 66.2
22. North Carolina 65.7
23. Tennessee 65.6
23. Oklahoma 65.6
24. Michigan 65.4
25. Oregon 64.2
26. Florida 63.9
27. Idaho 63.3
28. Wyoming 63.0
29. Alaska 61.8
30. Minnesota 59.3
31. Iowa 58.9
32. Nebraska 56.5
33. Montana 55.2
By Todd Zwillich, reviewed by Brunilda Nazario, MD
SOURCES: "The State of Diabetes in America," American Association of Clinical Endocrinologists, May 18, 2005. Jaime A. Davidson, MD, clinical associate professor, internal medicine, University of Texas Southwestern Medical School, Dallas. Lawrence Blonde, MD, member, American Association of Clinical Endocrinologists board of directors. Paul S. Jellinger, MD, president, American College of Endocrinology.
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