Diabetes clinics are falling short in their efforts to reach target goals in their patients, according to new research.
"We need to be much more aggressive in diabetes management," said Pardis Dana, MD, a research associate at the Endocrine and Diabetes Center in Vienna and Woodbridge, Virginia, United States.
The researchers looked at whether their subspecialty endocrine clinic was successful at reaching the target goals of HbA1c levels, blood pressure, and lipid levels set forth in ADA guidelines and at how their center compared with results from the National Health and Nutrition Examination Survey (NHANES) IV. According to NHANES IV, only 7% of diabetic patients are meeting these goals.
The investigators performed the assessment in 334 type 2 diabetic patients seen over 3 years. They evaluated initial and latest values of HbA1c, systolic and diastolic blood pressure, body mass index, low-density lipoprotein, high-density lipoprotein, triglycerides, and the use of various antidiabetic, antihypertensive, and lipid-lowering agents.
In the Endocrine and Diabetes Center, 28.7% of their patients reached all NHANES IV target goals in their most recent office visits. With application of ADA guidelines, however, 9.3% of patients reached five, 27.8% four, 27.8% three, 21.6% two, 10.2% one, and 3.3% none of the target goals.
Monotherapy antidiabetic agents were used in 24.9% of these patients; a two-drug regimen was used in 41.3%, a three-drug regimen in 22.5%, a three-drug regimen plus insulin in 6%; and lifestyle modification in 5.3%.
Regarding antihypertensive medications, 41.6% were taking one, 22.8% two, 8.4% three, and 3% more than three drugs; 24.2% of patients were not taking any antihypertensive drug.
In the lipid-lowering category, 62.9% were receiving monotherapy, 9% two drugs, and 28.1% no lipid-lowering therapy.
Dr. Dana concluded that achieving all five target ADA goals is very difficult. "There should be more aggressive drug therapy using higher doses, more drugs per patient, and better patient compliance," he said. "We are very behind target goals. We need to work much more aggressively."
Dr. Dana presented the results of a retrospective study here May 19th at the American Association of Clinical Endocrinologists (AACE) 14th Annual Meeting and Clinical Congress.
[Presentation title: Results of Implementation and Adherence to Diabetes Management Guidelines in an Endocrine Private Practice Setting.]