Can We Become Victims of Our Own Success?
- John B. Buse, MD, PHD
- From the Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
- Corresponding author: John B. Buse, jbuse{at}med.unc.edu.
The last 5 years seem to have marked a transition in the history of diabetes care. Whereas for two decades we have preached the importance of good glycemic control to manage the risk of diabetes-associated complications, the truth of the matter is that rarely did patients with diabetes achieve target A1C levels <7%. As reported in Diabetes Care in 20008 in an analysis of the National Health and Nutrition Examination Survey (NHANES) dataset, the odds ratio (OR) of people with diagnosed diabetes achieving an A1C <7% had increased 2.5-fold between 1999–2000 and 2003–2004. Most impressively, the average A1C among those treated with diet alone over the same interval had decreased from 7.04 to 6.07%, with 89.7% having an A1C <7% (1). Undoubtedly, this improvement is due in part to improved comprehensive management of diabetes as a result of better access to diabetes education and nutrition services, the rapid advances in the pharmacotherapy for diabetes, and better screening and diagnosis of diabetes. As reported in Diabetes Care in 2009 using the NHANES dataset, though the prevalence of diabetes continues to rise, …
