Glucose Monitoring in Type 2 Diabetics Is Often Inadequate

SAN FRANCISCO — Only about 40% of patients who were newly prescribed oral antidiabetes drugs received a fasting plasma glucose test, according to findings in a recent study.

In addition, only about half of patients received any hemoglobin A1c monitoring during the period beginning 90 days before the drug regimen started and lasting through the regimen's full course. And of the 50% whose HbA1c was monitored, 39% showed evidence of inadequate glycemic control, reported Shanthy Krishnarajah of Bristol-Myers Squibb at the annual scientific sessions of the American Diabetes Association.

The study population was derived from the Integrated Health Care Information Services National Managed Care Benchmark Database, a compilation of data from 40 million people enrolled in health plans in the United States.

Ms. Krishnarajah and her colleagues identified 53,772 patients, aged 18 years and older, with type 2 diabetes who received their first prescription for an oral antidiabetes drug between 2000 and 2006. Patients with any prior experience with oral antidiabetes drugs and those who weren't continuously enrolled in their health plans during treatment were excluded.

The patients were followed beginning 90 days before their initial prescription through any change in that initial drug regimen, which took place about 1 year after starting therapy.

ADA guidelines state that patients with type 2 diabetes have their glycemic control monitored at least twice a year, and as often as four times yearly if their glucose levels are not well controlled. Despite that, about 50% of the patients in this cohort did not have their HbA1c measured even once. “Fewer than 3% are getting their A1c tested [at the quarterly visit],” she said.

In patients whose glycemic control was measured, the average declines in HbA1c ranged from 0.91% for patients on sulfonylureas to 1.69% for those on thiazolidinediones. In those who had HbA1c levels recorded, however, 39% never demonstrated glycemic control during the oral antidiabetes drug regimen.

In a multivariate logistic regression analysis that controlled for all relevant variables, the only factors independently associated with a greater likelihood of HbA1c testing were female gender, membership in a point-of-service health plan, and total health care utilization. A lower likelihood of HbA1c testing was associated with Medicaid or Medicare patients and those aged 65 years or older.

Ms. Krishnarajah acknowledged the data set didn't capture self-monitoring of blood glucose or tests done in practices and that some newer classes were excluded.

SAN FRANCISCO — Only about 40% of patients who were newly prescribed oral antidiabetes drugs received a fasting plasma glucose test, according to findings in a recent study.

In addition, only about half of patients received any hemoglobin A1c monitoring during the period beginning 90 days before the drug regimen started and lasting through the regimen's full course. And of the 50% whose HbA1c was monitored, 39% showed evidence of inadequate glycemic control, reported Shanthy Krishnarajah of Bristol-Myers Squibb at the annual scientific sessions of the American Diabetes Association.

The study population was derived from the Integrated Health Care Information Services National Managed Care Benchmark Database, a compilation of data from 40 million people enrolled in health plans in the United States.

Ms. Krishnarajah and her colleagues identified 53,772 patients, aged 18 years and older, with type 2 diabetes who received their first prescription for an oral antidiabetes drug between 2000 and 2006. Patients with any prior experience with oral antidiabetes drugs and those who weren't continuously enrolled in their health plans during treatment were excluded.

The patients were followed beginning 90 days before their initial prescription through any change in that initial drug regimen, which took place about 1 year after starting therapy.

ADA guidelines state that patients with type 2 diabetes have their glycemic control monitored at least twice a year, and as often as four times yearly if their glucose levels are not well controlled. Despite that, about 50% of the patients in this cohort did not have their HbA1c measured even once. “Fewer than 3% are getting their A1c tested [at the quarterly visit],” she said.

In patients whose glycemic control was measured, the average declines in HbA1c ranged from 0.91% for patients on sulfonylureas to 1.69% for those on thiazolidinediones. In those who had HbA1c levels recorded, however, 39% never demonstrated glycemic control during the oral antidiabetes drug regimen.

In a multivariate logistic regression analysis that controlled for all relevant variables, the only factors independently associated with a greater likelihood of HbA1c testing were female gender, membership in a point-of-service health plan, and total health care utilization. A lower likelihood of HbA1c testing was associated with Medicaid or Medicare patients and those aged 65 years or older.

Ms. Krishnarajah acknowledged the data set didn't capture self-monitoring of blood glucose or tests done in practices and that some newer classes were excluded.

SAN FRANCISCO — Only about 40% of patients who were newly prescribed oral antidiabetes drugs received a fasting plasma glucose test, according to findings in a recent study.

In addition, only about half of patients received any hemoglobin A1c monitoring during the period beginning 90 days before the drug regimen started and lasting through the regimen's full course. And of the 50% whose HbA1c was monitored, 39% showed evidence of inadequate glycemic control, reported Shanthy Krishnarajah of Bristol-Myers Squibb at the annual scientific sessions of the American Diabetes Association.

The study population was derived from the Integrated Health Care Information Services National Managed Care Benchmark Database, a compilation of data from 40 million people enrolled in health plans in the United States.

Ms. Krishnarajah and her colleagues identified 53,772 patients, aged 18 years and older, with type 2 diabetes who received their first prescription for an oral antidiabetes drug between 2000 and 2006. Patients with any prior experience with oral antidiabetes drugs and those who weren't continuously enrolled in their health plans during treatment were excluded.

The patients were followed beginning 90 days before their initial prescription through any change in that initial drug regimen, which took place about 1 year after starting therapy.

ADA guidelines state that patients with type 2 diabetes have their glycemic control monitored at least twice a year, and as often as four times yearly if their glucose levels are not well controlled. Despite that, about 50% of the patients in this cohort did not have their HbA1c measured even once. “Fewer than 3% are getting their A1c tested [at the quarterly visit],” she said.

In patients whose glycemic control was measured, the average declines in HbA1c ranged from 0.91% for patients on sulfonylureas to 1.69% for those on thiazolidinediones. In those who had HbA1c levels recorded, however, 39% never demonstrated glycemic control during the oral antidiabetes drug regimen.

In a multivariate logistic regression analysis that controlled for all relevant variables, the only factors independently associated with a greater likelihood of HbA1c testing were female gender, membership in a point-of-service health plan, and total health care utilization. A lower likelihood of HbA1c testing was associated with Medicaid or Medicare patients and those aged 65 years or older.

Ms. Krishnarajah acknowledged the data set didn't capture self-monitoring of blood glucose or tests done in practices and that some newer classes were excluded.