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VA Tracks A1c Over Time to Evaluate Quality of Care

125 Veterans Health Administration facilities nationwide analyzed results over 2 years of the A1c test, the gold standard for monitoring how well patients have managed their diabetes in recent weeks and months.

A new study offers doctors another barometer to gauge the quality of care they give patients with diabetes. The study researchers are proposing an evaluation of diabetes care that tracks providers’ success over time instead of at a single moment.

“It’s kind of like a movie versus a snapshot,” said researcher Monika Safford, M.D. “Most of the ways we measure quality of care are looking at a snapshot.”

America’s health care systems already receive a report card on the quality of their diabetes care — an assessment largely based on A1c testing. Health plans are evaluated on the percentage of diabetes patients who receive the A1c test each year and the proportion of patients whose diabetes is out of control, based on an A1c score higher than 9 percent.

The A1c test detects a hemoglobin protein in the blood that is bound with glucose. As A1c levels rise, the risks for diabetes complications also increase and can result in damage to the cardiovascular system, eyes, kidneys or other organs.

The Veterans Health study, published in the December Health Services Research journal, tracked changes in average monthly A1c levels for each facility during two years. The majority of the facilities lowered their average-patient A1c levels during the study period.

“It’s a demonstration across a population that you can get A1c levels under better control,” Safford said.

To highlight differences, the researchers ranked each facility from worst to best based on average change in A1c levels. That kind of ranking could be used to identify the facilities that are the poorest performers and to determine those that need to improve the quality of their diabetes care, the study suggests.

Knowing how well a health plan is treating diabetes is valuable consumer information for anyone shopping for the best care, said Nathaniel Clark, M.D., national vice president of clinical affairs for the American Diabetes Association.

Thompson W, et al. Assessing quality of diabetes care by measuring longitudinal changes in hemoglobin A1c in the Veterans Health Administration. Health Services Research 40(6), 2005.

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FACT: Double Diabetes Cases Increasing: It’s a scene occurring with increasing frequency in doctors’ offices across America: A patient, usually overweight, comes in with all the symptoms of obesity-linked type 2 diabetes. But blood tests reveal antibodies to the pancreatic beta cells that produce insulin — a sign that the patient also has the rarer type 1 form of the disease. "We call it hybrid diabetes," said Dr. Francine Kaufman. In type 1 diabetes, the body’s immune system turns against beta cells in the pancreas that produce the insulin needed to regulate blood sugar. In the much more common, obesity-linked type 2 variety, increasing demand from the body fat’s cells causes a gradual shortfall of, and resistance to, insulin. While links between obesity and type 2 diabetes have long been clear, research is only just beginning to suggest it can also trigger late-onset type 1 disease.