title: Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  To evaluate the degree of glycemic control and its relationship with disease characteristics and antidiabetic treatment in patients with type 2 diabetes mellitus (DM), as well as the frequency of A1c use.
  
  
  METHODS
  For this purpose, an observational, cross-sectorial, and multicenter study was performed. A total of 443 patients were monitored in 17 Spanish primary healthcare centers. Demographic and clinical variables were recorded from the clinical history of patients.
  
  
  RESULTS
  Mean age was 68.9±12.0 years. Time of evolution of DM was 9.2±6.4 years. Mean A1c was 7.38±1.34% and 45% of patients achieved A1c <7%. There was a no significant relationship between the degree of control and time of evolution of DM. In 16% of patients no A1c determination was performed in the previous twelve months. In those patients in whom A1c was determined, 95% received pharmacologic treatment, and 31% insulin therapy. 66% of patients on monotherapy attained A1C <7%, compared with 39% and 23% of those receiving double- and triple-oral therapy, respectively (p<0.001). Only 21% of patients on insulin therapy achieved A1c <7%. The worst-controlled patients were those receiving oral antidiabetic agents and insulin (24% had A1c levels ≥9%).
  
  
  CONCLUSIONS
  A large proportion of patients are poorly controlled. Poor control increases according to complexity of treatment. A1c is underdetermined in many patients, likely related to clinical inertia.
authors: Centro de Salud La Ería, Asturias, Spain; Departamento de Medicina Preventiva y Salud Publica, Universidad de Oviedo, Asturias, Spain. Electronic address: margaovi@gmail.com.
authors: Margarita
authors: M
authors: Alonso-Fernández
authors: Centro de Salud Ciudad Jardín, Málaga, Spain.
authors: José
authors: J
authors: Mancera-Romero
authors: Centro de Salud Burgos Rural, Burgos, Spain.
authors: José Javier
authors: JJ
authors: Mediavilla-Bravo
authors: Centro de Salud La Puebla de Montalban, Toledo, Spain.
authors: José Manuel
authors: JM
authors: Comas-Samper
authors: Área Básica de Salud Martorell, Barcelona, Spain.
authors: Flora
authors: F
authors: López-Simarro
authors: Centro de Salud Dr. Castroviejo, Madrid, Spain.
authors: Ma Paz
authors: MP
authors: Pérez-Unanua
authors: Centro de Salud Casco Viejo, Álava, Spain.
authors: Jesús
authors: J
authors: Iturralde-Iriso
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013030:Spain; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Glycated hemoglobin; Primary healthcare; Type 2 diabetes