Physicians Are Slow to Step Up Treatment For Patients With High A1cs

A recent Canadian study examined administrative records of diabetic patients to see if specialists or primary care physicians gave them better care.

Non-insulin-requiring type 2 patients aged 65 or older who had A1C results greater than 8% were studied to see if drug intensification was given to treat increased A1C levels. A total of 591 patients were under specialist care, and 1,911 received only primary care.

Fewer than one half of patients with high A1C levels had intensification of their medications, regardless of the specialty of their physician. In the matched cohorts, 45.1 percent of patients with specialist care versus 37.4 percent with primary care had drug intensification. To measure drug intensification, researchers compared glucose-lowering drug regimens in four-month blocks before and after the elevated A1C test. The addition of a new oral drug, a dose increase of an existing oral drug or the initiation of insulin therapy all qualified as a measure of drug intensification. Specialists increased drug use more than primary care physicians mostly by initiating insulin therapy, which may explain the lower A1C levels seen with specialist care.

The researchers conclude that interventions assisting patients and physicians to recognize and overcome clinical inertia should improve diabetes care in this population.
Diabetes Care, March 2005

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