Blood glucose levels and glycaemic burden in 76,341 patients attending primary care: Bittersweet findings from a 9-year cohort study.
OBJECTIVE
Diabetes care is principally applied in the primary care setting whereby we examined trends in glycaemic levels and goals and estimated avoidable glycaemic burden.


METHODS
We retrieved glycated haemoglobin (HbA1C) results and glucose-lowering prescription records from a patient-based medical database during 2005-2013. There were 275,480 available HbA1Cmeasurements from 76,341 individuals managed by 960 general practitioners from 321 clinics across Australia. Change in mean levels and glycaemic control over time were assessed according to sex, age and glucose-lowering therapy. The time that HbA1Clevels exceeded 7% (53mmol/mol) in untreated (n=4888), non-insulin (n=11,534) and insulin treated (n=4049) patients was calculated as area under the curve (AUC) and months above threshold.


RESULTS
Average age of patients was 62.1±15.1years (47.1% women). HbA1Clevels decreased from 7.1% (54mmol/mol) in 2005 to 6.6% (49mmol/mol) in 2013 and the proportion of patients who achieved a HbA1Ctarget of <7% improved by 16% in men (53-69%) and 21% in women (55-76%). HbA1Clevels decreased with advancing age in men and increased with insulin treatment; correspondingly, HbA1Cgoal attainment increased and decreased, respectively. Avoidable glycaemic burden was 9.3±17.7months in untreated, 16.2±25.2months in non-insulin, and 26.8±34.6months in insulin-treated patients.


CONCLUSIONS
Amid considerable improvements, many treated patients still do not attain HbA1Clevels ≤7% and time spent above this threshold was delayed. Earlier and more vigorously intensified management may reduce lengthy periods of uncontrolled hyperglycaemia in primary care.
Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia. Electronic address: melinda.carrington@acu.edu.au.
Melinda J
MJ
Carrington
Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia. Electronic address: neale.cohen@bakeridi.edu.au.
Neale
N
Cohen
Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Wellington Rd, Clayton, VIC 3800, Australia. Electronic address: joshua.wiley@monash.edu.
Joshua F
JF
Wiley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
D001786:Blood Glucose; D007004:Hypoglycemic Agents
Diabetes; Glycaemic burden; Glycaemic control; HbA(1C); Primary care management; Secular trends