Evaluation of control of diabetes mellitus in a subspecialty clinic.
OBJECTIVE
To determine whether patients with diabetes under follow-up surveillance in a subspecialty clinic are receiving care that meets the guidelines recommended by the American Diabetes Association and American Association of Clinical Endocrinologists.


METHODS
We abstracted 2 years of medical records of patients sampled from 2 academic diabetes clinics, managed by board-certified endocrinologists. Information regarding the testing for and results of hemoglobin A1c (A1C), lipids, blood pressure, and microalbuminuria was recorded and analyzed.


RESULTS
The data on 499 patients were analyzed. More than 90% of patients had the recommended A1C, lipid, and blood pressure testing. Approximately 25% of patients had A1C levels >7%, and about 14% had A1C levels >6.5%. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were at target in approximately 82%, 65%, and 68% of patients, respectively. Approximately 55% of male and 50% of female patients had high-density lipoprotein cholesterol levels at target. Blood pressure was controlled in approximately a third of the patients. Approximately 30% of patients tested had microalbuminuria. Only 6.8% of patients in year 1 and 3.5% of patients in year 2 had all these risk factors (A1C, lipids, and blood pressure) at target levels.


CONCLUSIONS
The results indicate that in our subspecialty clinics, although testing for "risk factors" is being done at a high frequency, the targets for these risk factors are being met by only a limited number of patients. We believe that this result may be due to patient- or system-related factors but not due to physician knowledge. Therefore, emphasis should be placed on patient and system factors to improve the outcomes of the care of patients with diabetes.
Gossain
Ved V
VV
Department of Medicine, Michigan State University, East Lansing, Michigan 48824, USA. gossain@msu.edu
Rosenman
Kenneth D
KD
Gardiner
Joseph C
JC
Thawani
Hemant T
HT
Tang
Xiaoqin
X
D000328:Adult; D000419:Albuminuria / Q000378:metabolism / Q000473:pathology; D001794:Blood Pressure / Q000502:physiology; D003920:Diabetes Mellitus / Q000208:ethnology / Q000378:metabolism* / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000208:ethnology / Q000378:metabolism / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000378:metabolism / Q000473:pathology; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012907:Smoking
D006442:Glycated Hemoglobin; D008055:Lipids