Individualized A1C Targets versus A1C <7% as a Key Performance Indicator: Lessons Learned from a Tertiary Diabetes Center in Thailand
Nakasatien S, RN¹, Thewjitcharoen Y, MD¹, Butadej S, RN¹, Chotwanvirat P, MSc¹, Kittipoom W, MD¹, Krittiyawong S, MD¹, Himathongkam T, MD¹
Affiliation : ¹ Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
Background: Shortcomings of one-size-fits-all dichotomous A1C target had been addressed in various diabetes guidelines.
However, performance measurement data are very limited to document the impact of A1C goal achievement through individualized
A1C targets.
Objective: To compare the rate of goal achievement with individualized A1C targets versus A1C of less than 7% from the database of annually audited medical records.
Materials and Methods: One thousand two hundred randomly selected type 2 diabetes patients medical records at Theptarin Hospital, a multidisciplinary based diabetes center in Bangkok, were audited between 2015 and 2017 and the rates of goal achievement with individualized A1C targets versus A1C below 7% were examined.
Results: During the present study period, 1,200 medical records were reviewed (female 50.5%, mean age 65.1±12.8 years, duration of diabetes 14.1±10.0 years). The average A1C was 7.1±1.2% and 51.6 % of the patients had an A1C of less than 7%. While 51.6% of the patients achieved an A1C level of less than 7%, 58.3% of the patients achieved the individualized A1C goal. The patients who failed to achieve the individualized goal showed higher rate of insulin usage in comparison to those who achieved the goal.
Conclusion: The application of individualized A1C targets resulted in an achievement rate that was 6.7% higher in comparison to a target A1C level of less than 7%. These results highlight that physicians should document an individualized glycemic treatment goal and periodic evaluation should be done to prevent over-treatment or under-treatment in diversified diabetic patients.
Received 23 Jul 2019 | Revised 9 Jan 2020 | Accepted 15 Jan 2020
Keywords : Individualized A1C, Targets, Key performance, Indicator, Thailand
