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Diabetes management: practice what you preach

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American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress

Due, in part, to less aggressive type 2 diabetes management, the number of patients reaching their target HbA1c levels is declining, according to Jennifer B. Marks, MD, FACP, FACE.

“Today, almost everyone agrees that aggressive control and trying to get HbA1c down as close to normal as possible without causing undue hypoglycemia is the way to go in most patients with type 2 diabetes,” said Marks, who is professor of medicine at the University of Miami Miller School of Medicine.

“Despite that fact, for some reason, we do not practice aggressive management the way we talk about it,” she said.

Marks’ presentation highlighted treatment options for patients with diabetes, including lifestyle modification, sulfonylureas, meglitinides, alpha glucosidase inhibitors, incretin-based therapies and insulins.

Using the NHANES data, Marks highlighted the decline in the proportion of patients who reached their target HbA1c levels. Between 1988 and 1994, NHANES data reported 44.5% of patients reaching a target HbA1c of 7.0% or less. Between 1999 and 2000, that percentage dropped to 35.8%.

“The reasons for this are not clear, but what is clear is that we are not reaching the HbA1c targets that we have set for ourselves. It is not a lack of drugs; we have medications that will target virtually every mechanism that we understand as contributing to the development of hyperglycemia in type 2 diabetes,” she said.

The reasons why available interventions are not being utilized to their maximum potential remain unclear, according to Marks.

Whether good or bad, insulin use in the United States remains low, despite poor control, according to Marks. Continuing with data from NHANES, Marks discussed a decrease in the number of patients relying on diet only. The number of patients using oral agents and those using oral agents in combination with insulin has gone up. – by Stacey L. Adams

For more information:

• Marks JB. Clinical strategies for type 2 diabetes. Presented at: the American Association of Clinical Endocrinologists 17^th Annual Meeting & Clinical Congress; May 14-18, 2008; Orlando, Fla.