Despite the wide range of medications available, meeting the goals of diabetes treatment remains a challenge for many patients, as evidenced by recent data from the National Health and Nutrition Examination (NHANES). The NHNES data was collected from 2009-2010. The proportion of patients with T2D who reached an A1C goal of less than 7% was only 55% in 2010, therefore, 45% of patients with type 2 diabetes still did not reach their goal of treatment within one year of diagnosis, while only 8% of patients achieved combined treatment goals, which included A1C, blood pressure, lipids and weight loss.
The chronic and progressive nature of type 2 diabetes is evident from the data of the UK Prospective Diabetes Study (UKPDS). In this 10-year study, patients were assigned to conventional therapy (diet) or intensive therapy (a sulphonylurea, metformin or insulin). The median A1C in the first 5 years of follow-up was 6.7% in the intensive group, compared to 7.5% in the conventional group. In the last 5 years of follow-up, the A1C in the intensive and conventional groups was 8.3% and 8.8%, respectively. Despite intensive therapy, glycemic control still deteriorates over time.
Achieving the recommended goals for glycemic control may remain a challenge, especially if a gradual and conservative approach is used for the treatment of type 2 diabetes, and it has been shown that uncontrolled patients can take between 1.2 and 3 years to receive additional treatment. .
Both the patient's factors (that is, the difficulty in understanding and following strict dietary restrictions) and the medical factors (the perceived risk of unknown outcomes) can contribute to clinical inertia. These factors can be aggravated by insufficient communication between patients and doctors.
In a retrospective study of the General Electric Centricity Medical Records database, among patients who did not achieve an A1C of 7.5% in metformin therapy, the chances of reaching glycemic targets were 36% higher with intensification early treatment compared to late intensification.
Video credits to Battling A1C YouTube channel