Despite More A1C Testing, Diabetes Control Plateaus Interview with:
Saeid Shahraz, MD, PhD
Heller School of Social Policy and Management
Brandeis University
Waltham, Massachusetts What is the background for this study?

Response: Previous researchers had shown a significant improvement in diabetes control in the US between the years 1998 and 2010. We wanted to show if the betterment in diabetes control continued after then.

As previously, we measured hemoglobin A1C that shows the extent to which blood glucose level is under control.

Our main finding was that this upward improving trend plateaued for years after 2007 up to 2014, the last year for which we had data. We examined both genders, white and non-white populations as well as three age groups; young, middle age, and elderly population and results were the same: no change.

Overall, in 2007, 14% of patients with diabetes showed a poor diabetes control (Hemoglobin A1C more than 9%) ; in 2014, 15% of patients with diabetes fell within the category of poor diabetes control. 55% of the patients had a Good control of diabetes (Hemoglobin A1C less than 7%) in 2007; this measure was 54% in 2014.

To measure the changes over time, we used a similar method of calculation as used by the previous researchers. Despite no significant change in hemoglobin A1C over time, we observed a 23% increase in blood testing for measuring Hemoglobin A1C from 2007 (55%) to 2014 (78%). All of the subgroups of our study showed similar increase in the blood testing. Interestingly, the proportion of the patients with diabetes who were aware of their hemoglobin A1C results in the past year showed a 22% jump between these two periods and reached to 74% in 2014. Furthermore, the study population who were aware of their target Hemoglobin A1C, set by their physician, increased by almost 16% from 2007 and reached to a historically high level of 90%.

Unfortunately, those in the youngest age group (20-44 years old) showed little change in the two awareness measures, although young patients with diabetes are those who potentially benefit the most from a prudent diabetes care. What should readers take away from your report?

Response: Despite a significantly more blood testing for measuring Hemoglobin A1C and a prominent increase in the proportion of patients with diabetes who are aware of their test results and target treatment, diabetes control has reached to an unexpected stagnant trend.

Moreover, young people with diabetes show no improvement in the awareness measures. This is unfortunate as these patients could highly benefit from a better care. What recommendations do you have for future research as a result of this study?

Response: Our study only shows the overall trend in diabetes care in the United States. It’s very likely that diabetes care has improved over the two study periods in some geographic regions or even worsened in some other regions. Further research with more data is needed to identify geographic disparity in diabetes care. Also, it will be insightful to show reasons behind plateauing the improvement trajectory of diabetes control. We were not able to provide a logical link between the number of blood testing or the awareness measures with diabetes control.

More research using appropriate data and methods may help explore the casual pathway among these measures of diabetes quality of care. And last but not the least, further information on barriers of a good diabetes care for young patients with diabetes is crucial. Obviously, overall quality of diabetes care can be positively impacted by provision of a better care for young patients with diabetes in the United States and the world in general. Thank you for your contribution to the community.


Shahraz S, Pittas AG, Saadati M, Thomas CP, Lundquist CM, Kent DM. Change in Testing, Awareness of Hemoglobin A1c Result, and Glycemic Control in US Adults, 2007-2014. JAMA. 2017;318(18):1825–1827. doi:10.1001/jama.2017.11927

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on November 16, 2017 by Marie Benz MD FAAD