Gains come soon after diagnosis then plateau; young male adults fare worse
than females
Test results found to worsen in winter
Six-year data released from nation's largest laboratory testing database
CHICAGO, June 23 /PRNewswire/ -- Over the last six years, Americans being
treated for diabetes improved control of their disease by a significant 44.4
percent. As of December, 2006, more than half (54.6 percent) had reached
treatment goals for glycemic control, established by the American Diabetes
Association (ADA), compared to 37.8 percent in 2001. This finding is according
to the Quest Diagnostics Health Trends Report on Diabetes, (NYSE: DGX)
presented here today at the ADA annual scientific conference (posters # 21-LB
and 22-LB). Despite these overall gains, hemoglobin A1c (HbA1c or A1c) values
have plateaued since 2004 with 45 percent of patients in 2006 failing to reach
treatment targets of HbA1c levels less than seven percent.
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A companion analysis of HbA1c tests revealed a significant seasonal
variation in blood glucose control with HbA1c levels peaking in the winter
(January-March) and falling in the summer (July-October.) These seasonal
differences depended on patient age and level of A1c control, but were most
apparent in the elderly (greater than or equal to 80) and those with the
highest levels of HbA1c (greater than or equal to 9 percent).
The Quest Diagnostics Health Trends Report on Diabetes is based on
findings from 22.7 million de-identified HbA1c tests, a key indicator of
diabetes control, performed by Quest Diagnostics between 2001 and 2006 on 4.8
million patients who saw a healthcare professional and were classified as
having diabetes. The number of tests reported is more than 50 times that of
other published reports on diabetes health.
"These data demonstrate incredibly significant improvements in diabetes
management in the last six years, probably due to improved education, new
medications and adherence to treatment guidelines," said study co-author
Francine R. Kaufman, M.D., professor of pediatrics at the Keck School of
Medicine, University of Southern California, and past president of the ADA.
"But more than four in 10 people with diabetes still fail to reach treatment
goals, which indicate physicians and patients must continue to be committed to
management of medication, physical activity, food intake and glucose
monitoring."
The HbA1c test measures the amount of sugar attached to hemoglobin, the
primary protein in red blood cells, and indicates a patient's average blood
sugar level over the previous two to three months. The ADA recommends that
people with diabetes maintain their hemoglobin A1c levels below seven percent
of the total hemoglobin in red blood cells. According to the National Diabetes
Information Clearinghouse, studies have found that, in general, every
percentage point drop in HbA1c levels (from eight percent to seven percent for
example) reduces a patient's risk of eye, kidney, or nerve related
complications by 40 percent.
In patients with Type 2 diabetes, the overall mean HbA1c values declined
from 7.6 percent in 2001 to 7.3 percent in 2003. The rate of decline slowed
significantly thereafter, stabilizing at 7.2 percent in 2006 -- a five-percent
drop over five years. Men with diabetes between the ages of 20 and 39 fared
the worst, and the study authors suggested that strategies targeting this
group may be especially beneficial.
"The HbA1c plateau mirrors the clinical progression of the disease and
treatment patterns," said study co-author Richard W. Furlanetto, M. D. Ph.D.,
medical director, Endocrinology, Quest Diagnostics, Nichols Institute. "The
newly diagnosed patient tends to be diligent and first-year treatment tends to
be aggressive, so we often see relatively large improvements in blood sugar
control and HbA1c levels. In subsequent years the diabetes itself worsens and
the therapy gets less effective. Also, as blood sugar control improves, the
risk of hypoglycemia or low blood sugar, increases and this limits therapy.
Finally, over time patients may become less diligent in following their
treatment plan. It is in these post-diagnosis years that we must stress
patient monitoring and treatment compliance," Furlanetto continued.
The seasonality shifts are among the most striking finding in the data,
authors said, and may allow physicians to exert more control over testing and
treatment schedules. According to study authors, serial HbA1c levels should be
obtained in late spring and autumn to minimize the impact of seasonal
fluctuations on the interpretation of HbA1c levels.
Diabetes is a growing public health concern in the U.S. More than 20
million Americans -- 10 percent of all men and 8.8 percent of all women - are
currently diagnosed with diabetes, according to the U.S. Centers for Disease
Control and Prevention. A chronic condition in which the body does not produce
or properly use insulin to convert sugar into energy, diabetes can lead to
serious complications such as heart attack, stroke, blindness, amputation and
kidney failure if it is undiagnosed or poorly managed.
Study Methodology
The Quest Diagnostics Health Trends (TM) Diabetes Report is based on an
initial review of 44.4 million de-identified hemoglobin A1c test results
performed from 2001 through 2006 by Quest Diagnostics laboratories in the
United States on patients whose physicians classified them as having diabetes
through the use of specific diagnostic (ICD-9) codes. This classification
yielded 110,000 subjects with Type 1 diabetes, 1.9 million with Type 2
diabetes, and 2.8 million subjects with no clear classification for diabetes.
These patients had a total of 22.7 million test results from 2001-2006. For
the longitudinal analyses by season, age and gender, at least two HbA1c tests
results were required for each subject.
Quest Diagnostics Health Trends
Quest Diagnostics maintains the largest private clinical laboratory data
warehouse in the United States. Consisting of 17 billion data points, and
growing by 10 million a day, the database provides laboratory information on
the vast majority of conditions and diseases affecting Americans today. Quest
Diagnostics provides these data to health plans to help manage the health of
their members, and to state and local government to help monitor population
health. Quest Diagnostics Health Trends Reports identify and track disease and
wellness benchmarks. De-identified data are made available as a public service
to inform patients, health professionals, and policy-makers about the current
status of the nation's health.
About Quest Diagnostics
Quest Diagnostics is the leading provider of diagnostic testing,
information and services that patients and doctors need to make better
healthcare decisions. The company offers the broadest access to diagnostic
testing services through its national network of laboratories and patient
service centers, and provides interpretive consultation through its extensive
medical and scientific staff. Quest Diagnostics is a pioneer in developing
innovative new diagnostic tests and advanced healthcare information technology
solutions that help improve patient care. Additional company information is
available at: http://www.questdiagnostics.com.
The statements in this press release that are not historical facts or
information may be forward-looking statements. These forward-looking
statements involve risks and uncertainties that could cause actual results and
outcomes to be materially different. Certain of these risks and uncertainties
may include, but are not limited to, competitive environment, changes in
government regulations, changing relationships with customers, payers,
suppliers and strategic partners and other factors described in the Quest
Diagnostics Incorporated 2006 Form 10-K and subsequent SEC filings.
SOURCE Quest Diagnostics
CONTACT: Nancy Fitzsimmons or Wendy Bost, both of Quest Diagnostics,
+1-201-393-5700
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Web site: http://www.questdiagnostics.com