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Complete Health Indicator Report of Diabetes Hemoglobin A1C Tests

Definition

Percentage of adults aged 18 or older with diagnosed diabetes who self-report they had at least two A1C tests during the prior 12 months.

Numerator

Number of adults 18 or older with diagnosed diabetes who had at least two A1C tests in the past 12 months.

Denominator

Total number of surveyed adults 18 or older who were ever told by a health care professional that they had diabetes (excludes women with a history of gestational diabetes). Responses of "Don't know" and "Refused" were excluded from the analysis.

Data Interpretation Issues

Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. More details about these changes can be found at: [http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf].

Why Is This Important?

Proper diabetes management requires regular monitoring of blood sugar levels. Glucometers provide immediate feedback on blood sugar levels. An A1C test, however, tells a person what his or her average blood sugar level has been over the past two or three months and is a more reliable indicator of blood sugar control. An A1C level indicates the amount of sugar that is attached to red blood cells (hemoglobin cells). Red blood cells are replaced every two or three months and sugar stays attached to the cells until they die. When levels of blood sugar are high, more sugar is available to attach to red blood cells. For most people with diabetes, the target A1C level is less than 7 percent. Higher levels suggest that a change in therapy may be needed. Therefore, obtaining regular A1C tests plays an important role in diabetes management. The American Diabetes Association recommends that people with diabetes have an A1C test at least two times a year. However, the test should be conducted more often for individuals who are not meeting target blood sugar goals, or who have had a recent change in therapy. (See [http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s15#T7])

Healthy People Objective D-11:

Increase the proportion of adults with diabetes who have a glycosylated hemoglobin measurement at least twice a year
U.S. Target: 71.1 percent

Other Objectives

The American Diabetes Association recommends a target A1C level of less than 7%. This level corresponds to an average plasma blood glucose level of 170 mg/dL over the past 60-90 days. The Healthcare Effectiveness Data and Information Set (HEDIS) uses indicators to measure performance by health plans in the U.S. The HEDIS A1C indicator measures the number of insured adults who have at least one A1C test a year. Please see the HEDIS A1C indicator that is included in the IBIS-PH list.

How Are We Doing?

The percentage of people with diabetes who had at least two A1C tests a year is approximately 70% in Utah and in the U.S. Because of the change in methodology that began in 2009, information for this indicator is limited to 2009 and later.

How Do We Compare With the U.S.?

When crude (unadjusted) rates for Utah are compared with rates for the U.S., Utah fares worse, 69.9% vs. 71.9%, respectively. However, once rates are adjusted for age differences, the rate for Utah is higher than that for the U.S., 67.0% vs. 66.0%, respectively. (2009-2011 aggregate data)

What Is Being Done?

A public service announcement, "Do you wish you could reverse time?" is available for view at [https://www.youtube.com/watch?v=vWJkgo8XYNc] in English and Spanish.

Evidence-based Practices

Diabetes self-management education is one of the best examples of an evidence-based practice. Diabetes educators help individuals with diabetes take the proper steps to maintain an A1C level of less than 7%.

Available Services

The EPICC Program holds monthly webinars for health care professionals interested in learning the latest techniques and research for diabetes management. Information and registration is available at: [http://www.choosehealth.utah.gov/healthcare/continuing-education/diabetes-webinar-series.php] Diabetes care manuals for patients are available in multiple languages are available at: [http://www.choosehealth.utah.gov/healthcare/physician-resources/diabetes-manuals.php] A list of self-management education programs taught by health care professionals is available at: [http://www.choosehealth.utah.gov/your-health/lifestyle-change/dsme.php] A list of free community diabetes self-management workshops taught by members of the community is available at [http://www.choosehealth.utah.gov/your-health/lifestyle-change/living-well.php] A diabetes self-management course is also available online, [http://www.ncoa.org/improve-health/chronic-conditions/better-choices-better-health.html] Please see the National Diabetes Education Program for more information about diabetes prevention and management at [https://www.cdc.gov/diabetes/ndep/index.html]

Health Program Information

Individuals seeking more information about diabetes management are welcome to call the toll-free Health Resource Call Center at 1-888-222-2542.


Related Indicators

Relevant Population Characteristics

Members of minority racial and ethnic groups tend to have a higher risk of developing diabetes. The risk of diabetes in the Hispanic/Latino population is twice that for the non-Hispanic White population. The risk in the African American population is 60% higher than the risk for the non-Hispanic White population. The highest risk for developing diabetes is generally seen among Native Americans, where, in some tribes, over half of the adults aged 35 and older have diabetes.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Equipment is available to measure A1C levels in as little as eight minutes. Some companies have developed portable A1C monitors that can be used to test individuals' A1C levels outside of a physician's office.

Related Health Care System Factors Indicators:


Risk Factors

As A1C levels increase, the risk of cardiovasular failure increases, for both people with and without diabetes (Arch Intern Med. 2008 Aug 11;168(15):1699-704). A one percentage decrease in A1C level can reduce to the risk of microvascular (eye, kidney, nerve disease) by as much as 40 percent (2012 Diabetes Report Card).

Related Risk Factors Indicators:


Health Status Outcomes

Tight control of A1C levels (i.e., maintaining a level of less than 7%) has been shown to be associated with substantial reductions in kidney disease and blindness among people with diabetes. Regular A1C exams can help people with diabetes maintain better blood sugar control. Regular A1C exams can lead to early detection and treatment for poor blood sugar control and help prevent complications.

Related Health Status Outcomes Indicators:




Graphical Data Views

Adults With Diabetes Who Had at Least Two Hemoglobin A1C Tests in the Past 12 Months (Age-adjusted) by Local Health District, Utah, 2009-2011

::chart - missing::
confidence limits

The figure above shows age-adjusted rates of diabetes by local health district. Southeast Local Health District has the highest rate of A1C testing at 75.2%. Tooele County Local Health District has the lowest rate of adults with diabetes who had 2 or more A1C tests in the past year at 57.9%.
Local Health DistrictAge-adjusted Percentage of Adults With DiabetesLower LimitUpper Limit
Record Count: 15
Bear River63.8%50.2%75.6%
Central61.5%48.4%73.1%
Davis County69.1%61.0%76.2%
Salt Lake County61.6%51.4%70.8%
San Juan69.8%62.3%76.4%
Southeast75.2%64.3%83.6%
Southwest74.7%61.0%84.8%
Summit61.9%43.0%77.8%
Tooele57.9%48.9%66.5%
TriCounty60.3%47.3%72.1%
Utah County60.1%49.9%69.5%
Wasatch68.7%61.0%75.6%
Weber-Morgan72.0%63.2%79.5%
State of Utah67.0%60.9%72.7%
U.S.66.0%61.6%70.1%

Data Notes

Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. This graph is based on the new methodology. More details about these changes can be found at: [http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf].   Prior to 2015 San Juan County was part of the Southeast Local Health District. In 2015 the San Juan County Local Health District was formed. Data reported are for all years using the current boundaries.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Adults With Diabetes Who Had at Least Two Hemoglobin A1C Tests in the Past 12 Months (Crude Rates) by Local Health District, Utah, 2009-2011

::chart - missing::
confidence limits

There is a range of nearly 16 percentage points in the percentage of adults with diabetes who receive two or more A1C tests per year. Davis County Local Health District has the highest percentage at 76.1%, and Summit County Local Health District has the lowest percentage at 60.4%. It is important to note that the variability may be, in large part, attributable to the make-up of the population in each local health district. In particular, the rate of insured adults with diabetes can have an important influence on the percentage of adults who receive two or more tests each year.
Local Health DistrictCrude Percentage of Adults With DiabetesLower LimitUpper Limit
Record Count: 15
Bear River69.2%59.0%77.9%
Central61.7%51.5%70.9%
Davis County76.1%68.7%82.2%
Salt Lake County71.7%67.6%75.4%
San Juan72.7%43.3%90.3%
Southeast63.2%54.1%73.2%
Southwest65.0%55.6%73.4%
Summit60.4%42.7%75.7%
Tooele70.1%61.0%77.9%
TriCounty68.3%58.3%76.9%
Utah County67.1%58.2%75.0%
Wasatch66.4%54.3%76.7%
Weber-Morgan70.2%63.0%76.5%
State of Utah69.9%67.3%72.3%
U.S.71.9%70.3%73.5%

Data Notes

Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. This graph is based on the new methodology. More details about these changes can be found at: [http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf].   Prior to 2015 San Juan County was part of the Southeast Local Health District. In 2015 the San Juan County Local Health District was formed. Data reported are for all years using the current boundaries.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

References and Community Resources

The American Diabetes Association provides a current listing of free or low-cost screening services, updated monthly. Go to http://www.diabetes.org or call 1-800-DIABETES. This organization is a great resource for all types of diabetes information for patients, family members, and health care professionals. References: Utah: Utah Behavioral Risk Factor Surveillance System 2000-2006 (http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=49&state=Utah&cat=preventive&Data=data&view=TO&trend=a1ctests&id=7) U.S.: U.S. Behavioral Risk Factor Surveillance System 2013 Gerstein HC, Swedberg K, Carlsson J, McMurray JJ, Michelson EL, Olofsson B, Pfeffer MA, Yusuf S. The hemoglobin A1c level as a progressive risk factor for cardiovascular death, hospitalization for heart failure, or death in patients with chronic heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Arch Intern Med. 2008 Aug 11;168(15):1699-704.

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 08/27/2012, Published on 07/21/2015
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 19 July 2018 2:03:33 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Fri, 26 May 2017 10:19:45 MDT