September 24, 2015

One-Third of Diabetes Patients Meet Treatment Goals

This is an interesting study; however, I think it is what you are not told that could add several caveats to the study. The study looked at blood glucose, blood pressure, and cholesterol levels as defined by the American Diabetes Association.

Because the study is behind a pay wall creates problems in finding some information and we are only given what the researchers want us to know to make the points they desire. Some of the caveats that I can see:
  1. How many of the participants have refused to take statins?
  2. How many of the participants have taken the blood pressure medications, but are resistant to the aim of the medication?
  3. What is the percentage of women to men?
  4. What is the percentage of each ethnic group?
  5. What is the age range and the average age?
Since only one third of the seniors with diabetes have the three aspects – diabetes, BP, and cholesterol under control as defined by the ADA guidelines, the above points could be very important and significantly affect the findings.

The study included 1,574 patients with diabetes, aged 65 years and older, in Maryland, Minnesota, Mississippi and North Carolina. The researchers looked at whether the participants met ADA guidelines for three key measures of good diabetes control: blood glucose, blood pressure and cholesterol levels.

The results indicated that only one in three of the patients had diabetes controlled as defined by the ADA guidelines.

I find the next almost amusing without the information in the above points. “Although some experts consider the ADA guidelines too demanding for seniors, even using less stringent measures, the researchers found that many of the patients did not have their diabetes under control.”

The study also found significant racial disparities, particularly in women, in how well diabetes is managed. Black women were much less likely than white women to have control of blood glucose, blood pressure and cholesterol levels.

"This research gives us a good picture of diabetes control in older adults and gets us thinking about what it means that older Americans are not meeting clinical targets and how we should address this from a public health perspective," study leader Elizabeth Selvin, PhD, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said in a school news release.

"There is tremendous debate about appropriate clinical targets for diabetes in older adults, particularly for glucose control. Are some older adults being over-treated? Are some being undertreated? These are questions for which we don't have answers."

I say that without more patient data, we can only speculate about the overtreatment or undertreatment. How stringent were the restrictions on exclusion from the study and did the participants need to match certain criteria? The American Diabetes Association guidelines call for hemoglobin A1C levels below seven percent, blood pressure under 140/90 mmHg and LDL cholesterol under 100 mg/dl. While 72 percent met the hemoglobin A1C level, 73 percent met blood pressure goals and 63 percent had good cholesterol levels, only 35 percent met all three targets.

When the target levels were raised to a less stringent level – hemoglobin A1C under eight percent, blood pressure under 150/90 mmHg and LDL cholesterol under 130 mg/dl – the results were better, but many still did not meet the targets. Ninety percent met the target for hemoglobin A1C, 87 percent for blood pressure and 86 percent for cholesterol. Yet only 68 percent had their diabetes well controlled by meeting all three targets.

More research is needed to determine what the best control targets are in an older population. The researchers say that each patient needs to be carefully considered individually. A 70-year-old with newly diagnosed diabetes and no other major illnesses should probably be treated differently than someone who is 70 but has long-standing diabetes and is struggling with other major health issues, yet guidelines often consider these two patients to be similar.

The researchers say more also needs to be understood about racial disparities in diabetes control, particularly with regard to women. The racial differences persisted even when the researchers accounted for factors such as income and education levels. White women were 58 percent more likely than black women to meet all three clinical targets.

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