New research shows inadequate blood sugar testing leaves millions of people with type 2 diabetes at risk of life-threatening complications (18 Sep 2007)
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A global survey of healthcare professionals (HCPs) and patients presented today at the European Association for the Study of Diabetes (EASD) in Amsterdam, the Netherlands, demonstrates suboptimal use of HbA1c testing in clinical practice in a wide range of countries, leaving millions of people in poor control of their type 2 diabetes and at risk of long-term complications.
The survey, which was conducted by a Global Task Force (GTF) on Glycaemic Control, a panel of 15 global experts in diabetes and endocrinology, in association with Novo Nordisk, questioned nearly 1,400 HCPs and over 1,000 patients in eight countries (UK, Poland, Turkey, Canada, Russia, Sweden, India and China). It aimed to evaluate their awareness, attitudes and behaviours towards the management of type 2 diabetes, and to identify key barriers to good glycaemic control. The survey specifically investigated awareness and use of the HbA1c test, which is the only method of measuring long-term blood sugar levels (also referred to as glycosylated haemoglobin), and results demonstrate a clear gap between guideline recommendations on glucose monitoring and clinical reality.
“Achieving good glycaemic control is vital for people with type 2 diabetes, but this new survey shows that patient awareness and understanding of HbA1c testing is limited, and its value in the wider management of the condition is underestimated by HCPs,” commented Dr Kerstin Berntorp, member of the GTF on Glycaemic Control, Department of Endocrinology, Malmö University Hospital, Sweden. “Each 1% reduction in HbA1c decreases the risk of damage to the retina, kidneys and nerve function by 37%, and the risk of diabetes-related death by 20%. These figures demonstrate the importance of controlling blood glucose levels and they should not be overlooked.”
Despite the fact that the HbA1c test is recognised as part of a series of tests needed for optimal treatment of type 2 diabetes, and current guidelines from the International Diabetes Federation (IDF) recommend that testing takes place every two to six months if clinicians are to effectively relate individual blood glucose control to risk of complication development,1,2 the survey shows that it is used far too infrequently.
Furthermore, communication about the importance of the test is inadequate, and patient awareness and understanding of HbA1c is low. These factors are likely to contribute greatly to the suboptimal glycaemic control observed in many countries3–7, including those that participated in the survey. In addition, short and infrequent consultations often due to stretched healthcare systems, as well as treatment adherence issues with regard to complex regimens and negative preconceptions about insulin among patients, were identified as key barriers to improving glycaemic control.
“This new data is very important for the future management of type 2 diabetes,” said Professor Eric Kilpatrick, chairman of the GTF on Glycaemic Control, Hull Royal Infirmary, UK. “Not only is the problem of poor glycaemic control very real in most countries, and becoming a major medical and economic challenge worldwide, it is linked to issues that we can change. Many patients with diabetes are not achieving the HbA1c level of 6.5%, the target level recommended by the IDF if the risk of developing complications is to be minimised. The GTF is working to identify practical solutions that will motivate and enable physicians and their patients to test HbA1c more regularly. We believe that education is key, and are currently developing management recommendations, and will be working to implement these with full guidance for clinical practice in 2008.”
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Notes to editors
About the HbA1c survey
The survey consisted of both a quantitative and a qualitative phase carried out by three independent research organisations in eight countries; UK, Poland, Turkey, Canada, Russia and Sweden (Aequus Research), India (AC Nielsen) and China (Synovate).
· Quantitative data
§ 1,357 HCPs and 1,006 patients participated in 20-minute telephone interviews
· Qualitative data
§ 185 HCPs and 95 patients participated in one-hour face-to-face interviews aiming to assess the underlying causes of the difference between the guidelines and clinical reality
· Demographics and characteristics
§ All patients involved were treated for type 2 diabetes, either with insulin or oral antidiabetic drugs (OAD) monotherapy, or with a combination of both insulin and OAD. HCPs included general practitioners, specialist consultants and nurses (where relevant).
§ The frequency of visits with HCPs varied from once monthly to once yearly between the countries surveyed
§ The duration of consultations varied from 5–10 minutes in China, to 19 minutes in India and 30 minutes in Sweden
· Awareness of HbA1c
§ HCPs were the most widely cited source of information in all eight countries
§ Patient awareness of HbA1c differed between the eight countries in the survey, with highest levels of awareness found in Sweden, where about nine out of 10 patients were aware, and the lowest in India and China, where only one or two out of 10 patients knew about the test
· HbA1c testing
§ The majority of HCPs in all the surveyed countries cited HbA1c as an important tool in effective diabetes management
§ In Sweden 62% of patients regard HbA1c as very important, compared with 32% of patients in Russia (on a scale of 1 to 5 [5 being ‘very important’])
§ Over 90% of HCPs in Sweden said they tested their patients’ HbA1c level, compared with only 54% of HCPs in Poland
§ 50% of all HCPs surveyed measured HbA1c three or four times a year, however, discrepancies between the number of reported HbA1c tests from HCPs and patients were evident. For example, in China around 57% of HCPs stated they tested HbA1c four times a year, but only 28% of patients reported having this test carried out at this frequency
§ Of the patients who had their HbA1c tested, over half (61%) reported being given a target level
· Barriers to good glycaemic control
§ In countries where HbA1c was not commonly measured, HCPs mentioned lack of awareness and understanding as key barriers
§ In countries where HbA1c was commonly measured, HCPs mentioned their high awareness of the importance of meeting targets as a key reason for their success
§ Another potential barrier appeared to be patients’ negative preconceptions of insulin.
About the Global Task Force on Glycaemic Control
The Global Task Force (GTF) on Glycaemic Control comprises 15 global experts in diabetes and endocrinology who joined forces on World Diabetes Day 2006, in collaboration with Novo Nordisk A/S, to take action to address the escalating problem of poor glycaemic control in people with type 2 diabetes. The GTF recognises the need to change the current climate of reactive dialogue to active problem-solving by all stakeholders, and is working to develop practical solutions that will enable HCPs and their type 2 diabetes patients to achieve better treatment outcomes and greater control of their condition. The GTF’s Commitment to Act is the cornerstone of the IMPROVETM Control programme by Novo Nordisk, which includes a global medical and public awareness campaign aiming to deepen understanding of the importance of achieving and maintaining good glycaemic control in order to minimise the effects of poor glycaemic control on individuals and their healthcare systems. The IMPROVETM Control programme is not a stand-alone initiative, it is part of a broader undertaking by Novo Nordisk called Changing Diabetes. For more information about Changing Diabetes, visit changingdiabetes.com.
About Novo Nordisk A/S
Novo Nordisk is a healthcare company and a world leader in diabetes care. The company has the broadest diabetes product portfolio in the industry, including the most advanced products within the area of insulin delivery systems. In addition, Novo Nordisk has a leading position within areas such as haemostasis management, growth hormone therapy and hormone replacement therapy. Novo Nordisk manufactures and markets pharmaceutical products and services that make a significant difference to patients, the medical profession and society. With headquarters in Denmark, Novo Nordisk employs approximately 25,350 employees in 79 countries, and markets its products in 179 countries. Novo Nordisk’s B shares are listed on the stock exchanges in Copenhagen and London. Its ADRs are listed on the New York Stock Exchange under the symbol ‘NVO’. For more information, visit novonordisk.com.
1. European Diabetes Policy Group. A desktop guide to type 2 diabetes mellitus. Diabet Med 1999; 16:716–730
2. Manley S. Haemoglobin A1c – a marker for complications of type 2 diabetes. The experience from the UK Prospective Diabetes Study (UKPDS). Clin Chem Lab Med 2003; 41:1182–90
3. Martin TL, Selby JV, Zhang D. Physician and patient prevention practices in NIDDM in a large urban managed–care organization. Diabetes Care 1995; 18:1124–32
4. Weiner JP, Parente ST, Garnick DW, Fowles J, Lawthers AG, Palmer RH. Variation in office–based quality. A claims–based profile of care provided to Medicare patients with diabetes. JAMA 1995; 273:1503–8
5. Chuang LM, Tsai ST, Huang BY, Tai TY. Diabcare–Asia 1998 Study Group. The status of diabetes control in Asia––a cross–sectional survey of 24 317 patients with diabetes mellitus in 1998. Diabet Med 2002; 19:978–85
6. Charpentier G, Genès N, Vaur L, Amar J, Clerson P, Cambou JP, Guéret P. ESPOIR Diabetes Study Investigators. Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes: a nationwide French survey. Diabetes Metab 2003; 29:152–8
7. Monnier L, Grimaldi A, Charbonnel B, Iannascoli F, Lery T, Garofano A, Childs M. Management of French patients with type 2 diabetes mellitus in medical general practice: report of the Mediab observatory. Diabetes Metab 2004; 30:35–42