Glycemic control in diabetes in three Danish counties.
BACKGROUND
Hemoglobin A1c (HbA1c) is a proxy measure for glycemic control in diabetes. We investigated the trend for glycemic control in patients from three Danish counties using HbA1c measurements.


METHODS
We studied 2454 patients from a population of 807,000 inhabitants for whom routine monitoring of diabetes using HbA1c-DCCT aligned was initiated in 2001. We estimated the incidence of monitored patients in the population. The progress in patients with originally diabetic HbA1c levels was investigated by cumulative probability plots, and the individual trend in clinical outcome was investigated by a modified difference plot.


RESULTS
The age-standardized incidence of monitored patients was <0.5% in all regions. Patients with diabetic first HbA1c concentrations (>or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. The overall percentage above the treatment target (>or=6.62% HbA1c) was 51% in 2003 compared to 59% in 2001, and the percentage with poor glycemic control (>or=10.0% HbA1c) was reduced from 19% to 4%. Of patients with originally diabetic HbA1c levels, 15% showed progress in glycemic control, and 28% reached treatment targets. In patients with originally normal HbA1c, 75% showed an upward trend in HbA1c levels, which reached diabetic concentrations in 17%.


CONCLUSIONS
Patients with diabetic first HbA1c concentrations (>or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. In individual patients, 75% with originally diabetic HbA1c levels showed improved glycemic control after 3 years, while 78% with originally normal concentrations showed an upward trend in HbA1c levels.
Jørgensen
Lone G M
LG
The Laboratory Center, Department of Clinical Biochemistry, Vejle County Hospital, Vejle, Denmark, and Norwegian quality improvement of primary care laboratories, Division for General Practice, University of Bergen, Norway. lgmj@ofir.dk
Petersen
Per Hyltoft
PH
Heickendorff
Lene
L
Møller
Holger Jon
HJ
Hendel
Jørn
J
Christensen
Cramer
C
Schmitz
Anita
A
Reinholdt
Birgitte
B
Lund
Erik D
ED
Christensen
Niels J
NJ
Hansen
Erik Kjaersgaard
EK
Hastrup
Jens
J
Skjødt
Hanne
H
Eriksen
Ebbe Wendel
EW
Brandslund
Ivan
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D006442:Glycated Hemoglobin