HbA1c, better test to detect diabetes

Sun, 03 Jan 2010 15:09:06 GMT

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Hemoglobin A1c (A1c) is a faster and easier diagnostic test to detect diabetic patients, the American Diabetes Association (ADA) report says.

The A1c test, which measures average blood glucose levels for a period of up to 3 months, was previously only used to evaluate diabetic control over time.

According to the guideline recently released by ADA, HbA1c is a better test to identify undiagnosed individuals already suffering from prediabetes or diabetes.

"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease," said ADA president-elect of medicine and science Richard M. Bergenstal.

He stressed that the early detection of the condition is not only important in preventing disease and its complications but also in improving the quality of life in affected individuals.

For optimal diabetic control, the recommended ADA target for most diabetics is an A1c level no greater than 7%. As for detecting the condition, a cutoff point of 6.5% is considered, said the guideline to be published in the January supplement of Diabetes Care.

TEHRAN (FNA)- The results of studies in the US show that when pharmacists directly participate in patient care, they significantly reduce treatment costs and improve outcomes.

The role of pharmacists hasn't received much attention in the debate on the cost of health care. A study on diabetic patients by the University at Buffalo School of Pharmacy and Pharmaceutical Sciences identified cost savings with improvements in a key indicator of glucose control in diabetes patients, the hemoglobin A1C measurement.

The A1C provides a three-month average of the amount of excess glucose in the blood. Higher A1Cs indicate that a patient is at higher risk for developing long-term complications associated with diabetes, such as kidney disease or vision problems.

Published in the Journal of the American Pharmacists Association, the UB study of 50 patients with Type 2 diabetes demonstrated that in just six months clinical pharmacists, in collaboration with primary care providers, were able to significantly reduce patients' A1C levels.

In the UB study, patients' A1C levels were reduced by an average of 1.1 percent, from an average of 8.5 percent to 7.4 percent, one year after being enrolled in the program, while also improving the overall metabolic profile.

"Our results show that enhancing the patient's access to care through collaborative physician-pharmacist relationships can yield lower blood glucose levels, improve the overall metabolic profile and reduce costs to the payer," said Erin Slazak, PharmD, UB clinical assistant professor of pharmacy practice and board certified pharmacotherapy specialist.

These clinical improvements occurred while monthly costs per patient went down by approximately $212, around $2,500 per year, even though there were nominal increases in the cost of medications prescribed.

"Patients had unlimited access to pharmacists throughout the year," said Slazak.

Patients referred to the UB program had been identified by their primary care providers as having difficulty controlling their blood sugar.

Slazak notes that it was not uncommon to see patients with glucose levels as high as 400 mg/dl (normal levels are below 100 mg/dl).

The UB pharmacists spent an initial one-hour appointment with each patient, where they worked up detailed health records covering dietary information and all medications and disease conditions, and then reviewed them with each patient.

After that, patients could call or make appointments with pharmacists at will.

"We did extensive education with patients about how to manage their conditions," Slazak said.

"In many cases, we were instrumental in getting them to start insulin. There is a lot of resistance to that, and not just because it's an injection," Slazak noted.

For patients in the initial stages of administering insulin, she says it was common to be contacted once every few days. The pharmacists then made suggestions to physicians about changes in medications, dosages or lifestyle that might be beneficial to their patients.

That kind of individualized attention is far from the norm for diabetic patients.

"Nationwide, the standard of care is that the primary care provider manages diabetes alone," Slazak said. "Pharmacists typically do not have direct involvement."

That is partly because some states, including New York, have not yet approved collaborative practice agreements between physicians and pharmacists. In the Buffalo study, for example, physicians were required to review pharmacists' recommendations and approve all interventions first. Completion of the review process and approval occurred in only half of the cases, potentially limiting the overall benefit to the patient.

"We know there's a long-term clinical and economic benefit to pharmacists working directly with patients and we think that can continue to grow," said Scott V. Monte, PharmD, UB clinical assistant professor of pharmacy practice and director of Diabetes and Cardiovascular Research, CPL Associates, LLC, in Buffalo. "Pharmacists can help achieve better outcomes if given the chance."

The study was conducted through MedSense, part of the Pharmacotherapy Research Initiative, a collaborative effort between Lifetime Health Medical Group and UB, to study how pharmacists impact patient care.

MedSense is one of many program sites that are part of the UB Pharmacotherapy Research Initiative in the School of Pharmacy and Pharmaceutical Sciences, which was established to study how pharmacy medication management can improve the health of patients while cutting costs through patient-centered pharmacotherapy.

The program is jointly funded by Lifetime Health Medical Group and the UB School of Pharmacy and Pharmaceutical Sciences.

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