Sustained Hyperglycemia Among Patients With Diabetes What matters when action is needed?

OBJECTIVE — To estimate prevalence of, and factors associated with, sustained periods of hyperglycemia among patients with diabetes and factors associated with receipt of appropriate care once A1C values are persistently elevated. RESEARCHDESIGNANDMETHODS — Among patients initiating oral monotherapy (n 5,070), Kaplan-Meier and Cox proportional hazards methods were used to estimate time to, and factors associated with, sustained hyperglycemia (defined by two A1cs8 % and no recent medication intensification), and among those experiencing sustained hyperglycemia, time to, and factors associated with, appropriate receipt of care (i.e., medication intensification or achiev-ing A1C 7%). RESULTS — Within 1 year, 8 % experienced sustained hyperglycemia, with the proportion rising to 38 % within 5 years. Patients using sulfonylurea had greater risk of hyperglycemia (hazard ratio [HR] 1.47 [95 % CI 1.30–1.66]) compared with those initiating metformin. Risk increased with age (1.89 [1.27–2.83]), was greater for African Americans (1.19 [1.05–1.36]), and increased with A1C levels 7%. Among individuals with sustained hyperglycemia (n 1,386), mean time to appropriate care was 9.7 months, with 25 % not receiving appropriate car