Hemoglobin A1C and Achieving Diabetes Control

Percentage glycosylated hemoglobin A1C (A1C) is widely used for monitoring blood sugar levels in diabetic patients. Guidelines published by the American Diabetes Association (ADA) recommend that treatment for diabetes aim for A1C < 7%, and about half of all Americans with diabetes achieve this level.1 It is generally believed that achieving a target level depends on the frequency of monitoring, and the ADA recommends obtaining an A1C level at least twice yearly in patients who are meeting treatment goals and who have sta ble glycemic control and quarterly in patients whose ther apy has changed or who are not meeting treatment goals.2 However, these guidelines were based on expert consensus and clinical experience, and the evidence is considered level E; no study has been found to validate these guidelines. Fur thermore, discussions of frequency of testing have voiced concerns about undertesting and overtesting.3 The main objective of this study was to test the premise that persons who adhered to the guidelines would have better control. We also wished to determine what fraction of our patients were compliant with the guidelines and whether meeting target A1C level of <7 % correlates with other infor mation easily abstracted from patients records, namely age, gender, and types of therapy. Methods Our clinic service area in the twin tiers region of Pennsylvania and New York is largely rural, and the population is 97 % white. Health care is provided by family medicine physicians and residents, as well as by physician assistants. This study employed a retrospective case contro