The National Diabetes Education Program (NDEP) was established, in part, to improve treatment and outcomes for people with diabetes by increasing knowledge of A1C, blood pressure (BP), and LDL cholesterol; together, these components make up the “ABCs” of diabetes. Few studies, however, have explored patient knowledge of their ABC levels and the association between having this knowledge and adhering to treatment recommendations for each of the ABC components.
ABC Diabetes Knowledge From Patients Still Lacking
In Diabetes Care, my colleagues and I had a study published in which we sought to assess patient knowledge of ABC levels and the association between this knowledge and meeting the ABC target goals. We also evaluated the association between specific demographic and diabetes-related factors and ABC knowledge. The purpose was to see if these data could help physicians and researchers identify high-risk patients who had particularly low knowledge.
According to our findings, knowledge of the ABCs was suboptimal. Among patients with diabetes, our data showed that:
48% could report their last A1C level.
63% could report their BP level.
22% could report their last LDL level.
Knowledge was lower among Mexican Americans when compared with non-Hispanic whites and in people with less income and education. Having routine foot exams performed by physicians in the past year was associated with higher A1C knowledge. Nearly 20% of study participants reported that their healthcare provider did not specify an A1C goal. About three of every five participants reported that they were not informed of their BP or LDL cholesterol goals (47% and 41%, respectively).
Significant Implications on Controlling Diabetes
Physician communication of the ABC goals for diabetic patients is an important part of controlling these components of diabetes. However, communication of these goals alone may not be enough to improve adherence to treatment recommendations, and consequently, prevent diabetes-related complications.
“New strategies which extend beyond a ‘know your numbers’ approach may be warranted to improve control of the ABC components of diabetes.”
Our study suggests that new strategies that extend beyond a “know your numbers” approach may be warranted to improve control of the ABC components of diabetes. An increased understanding of the interaction between patient demographics, knowledge, and other diabetes-related factors as well as improved communication between physicians/educators and patients may enhance diabetes control and outcomes. Educational efforts should target groups with less diabetes knowledge.
Our study data are consistent with previous findings from NDEP and should prompt the development of multifactorial approaches that address psychosocial and behavior change components associated with diabetes self-management. In June 2011, NDEP launched Diabetes HealthSense (www.YourDiabetesInfo.org/HealthSense),a video series and online library of behavior change resources for people with diabetes. The program offers patients information on diabetes prevention, goal setting to improve health, patient support, and recommendations for physical activity and diet.
Readings & Resources (click to view)
Casagrande SS, Burrows NR, Geiss LS, Bainbridge KE, Fradkin JE, Cowie CC. Diabetes knowledge and its relationship with achieving treatment recommendations in a national sample of people with type 2 diabetes. Diabetes Care. 2012 Apr 12 [Epub ahead of print]. Available at: http://care.diabetesjournals.org/content/early/2012/04/11/dc11-1943.abstract.
American Diabetes Association. Standards of Medical Care in Diabetes—2012. Diabetes Care. 2011;35:S11-S63. Available at: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.
Iqbal N, Morgan C, Maksoud H, Idris I. Improving patients’ knowledge on the relationship between HbA1C and mean plasma glucose improves glycaemic control among persons with poorly controlled diabetes. Ann Clin Biochem. 2008;45:504-507.
HeislerM, Piette JD, SpencerM, Kieffer E, Vijan S. The relationship between knowledge of recent HbA1C values and diabetes care understanding and self-management. Diabetes Care. 2005;28:816-822.
Coberley CR, McGinnis M, Orr PM, et al. Association between frequency of telephonic contact and clinical testing for a large, geographically diverse diabetes disease management population. Dis Manag. 2007;10:101-109.
Harwell TS, Dettori N,McDowall JM, et al. Do persons with diabetes know their (A1C) number? Diabetes Educ. 2002;28:99-105.