Lowering A1c in Americans with Type 2Wednesday, July 02, 2014
The American College of Endocrinology (ACE) with support from Merck has expanded upon its Blood Sugar Basics program with the development of its Get to Your Goals initiative. The initiative is designed to be a collaborative effort between providers and patients with type 2 diabetes, using a goal-driven plan aimed at lowering the A1c statistics in this patient population in the United States.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
In a survey done some years ago, results showed that nearly half of those affected by type 2 diabetes in the United States were not at or under the American Association of Clinical Endocrinologists’ (AACE) recommended 6.5 percent A1c level.
Combine that data with the Center for Disease Control and Prevention’s (CDC) recent statistic that now over 29 million Americans have diabetes, and you have a mixture forming that could leave millions of Americans vulnerable to diabetes-related complications in the coming years.
Knowing the potential onslaught of medical issues people with diabetes could be facing, ACE—AACE’s educational and scientific arm—looked at ways to bring down A1c levels. ACE decided to complement its existing Blood Sugar Basics program by creating its new Get to Your Goals initiative. (To understand more about the Blood Sugar Basics program overall, read our past Up Close interview here with registered dietitian Samantha Heller.)
The Get to Your Goals initiative was set up as a step-by-step plan with three missions for people with diabetes to follow. The program is a collaborative process between patient and provider that opens up communication lines and gets patients engaged to take on more personal responsibility for their management.
Also understanding that the majority of Americans with type 2 are seen by primary care providers, this is a way for ACE/AACE to lend their expertise in diabetes care to this mounting medical issue.
Etie Moghissi, MD, FACP, FACE, who is Associate Clinical Professor of Medicine at the UCLA David Geffen School of Medicine and a clinical endocrinologist in private practice in Marina del Rey Calif., is working as an advisor for the Blood Sugar Basics program. She sees changing the national A1c statistics as the paramount goal. While she believes the majority of type 2 patients can reach the 6.5 percent threshold, she says the most significant portion of the initiative is to get people in their providers’ offices to begin a goal-driven dialogue so that appropriate, individualized A1c goals can be met.
DiabetesCare.net spoke with Moghissi about the specifics of the program, why many Americans are struggling to obtain the AACE-recommended A1c guideline, and the goals for the program.
DiabetesCare.net: Can you provide an overview of the Get to Your Goals initiative?
Moghissi: We know that ACE and AACE suggest an A1c of 6.5 for the majority of patients to avoid complications, but we also know nearly half of those who have diabetes do not obtain this A1c goal.
This initiative is designed to really encourage people with diabetes to first understand their diabetes and then try to get it under control. We know that A1c is the standard for diabetes control, and we would like patients to work with their healthcare professionals to set appropriate A1c goals that are right for them.
We would like patients to make lifestyle changes, including meal planning, exercise, and adhering to their medication regimen. And all of these things play an important role in getting diabetes under control.
DiabetesCare.net: Why do you think so many Americans are struggling to reach the 6.5 percent or less A1c standard?
Moghissi: As a clinical endocrinologist who cares for patients with diabetes, I understand that the disease can be very overwhelming, especially at diagnosis. Many patients do not realize the importance of glucose control. They say, ‘I feel fine.’ But they need to understand that even if they don’t have any symptoms right now, if they don’t control their blood sugar, it can lead to problems down the road.
We know 6.5 is an appropriate A1c goal for the majority of patients. However it’s also really important to set individualized goals because one size does not fit all either. There are the three main missions for the Get to Your Goals initiative. They include: encouraging patients to know their A1c; getting patients to work with their healthcare providers to set an A1c goal that is appropriate for them; and since diabetes is a progressive disease, periodically having providers review patients’ management plans and make any necessary changes.
We all have different challenges in our lives. We are busy; have different concerns; and sometimes, it is really difficult to focus on diabetes care. We want to have everybody understand they need to make their diabetes a priority, no matter what. If people understand the importance of their health, then they are more likely to make the necessary lifestyle changes.
DiabetesCare.net: Can you talk about your involvement in the program?
Moghissi: The majority of my patients have diabetes, and I know it’s overwhelming to understand the different aspects of diabetes management from making changes in diet, to exercising, and glucose monitoring. I have learned from my patients, that if they take charge of their lives they become more engaged.
DiabetesCare.net: As this is an ACE/AACE program, are you coordinating with other medical provider organizations to raise awareness?
Moghissi: Yes. As clinical endocrinologists, we are experts in diabetes, but we cannot take care of every patient with diabetes because there are not enough endocrinologists in the U.S. Therefore, many people with diabetes are cared for by primary care providers, and in the primary care setting things are extremely busy. These providers need tools for their diabetes patients. We are working with primary care organizations to provide this program to them so they have some guidance and get their patients engaged at the same time.
DiabetesCare.net: What are AACE’s goals for the program?
Moghissi: Our main mission is to change the statistics by providing tools like “Get To Your Goals” to patients and their physicians. We want more people to achieve the A1c standard so they can prevent complications.
For those interested in finding out more about the program, they can go to BloodSugarBasics.com to read more information on it.