Health Indicator Report of Diabetes Hemoglobin A1C Tests
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)
The figure above shows age-adjusted rates of diabetes by local health district. Southwest Local Health District has the highest rate of A1C testing at 74.7%. 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%.
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
NotesBeginning 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.
Data SourceUtah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
Data Interpretation IssuesBeginning 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.
DefinitionPercentage of adults aged 18 or older with diagnosed diabetes who self-report they had at least two A1C tests during the prior 12 months.
NumeratorNumber of adults 18 or older with diagnosed diabetes who had at least two A1C tests in the past 12 months.
DenominatorTotal 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.
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 ObjectivesThe 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 http://health.utah.gov/diabetes/aboutdiabetes/pagelinks.htm in English and Spanish. A brochure that explains the A1C exam is available on the same link. The Diabetes Prevention and Control Program (DPCP) also hosts professional education seminars to promote A1C awareness.
Evidence-based PracticesDiabetes 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 ServicesThe 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 www.yourdiabetesinfo.org
Health Program InformationIndividuals seeking more information about diabetes management are welcome to call the toll-free Health Resource Call Center at 1-888-222-2542.
Page Content Updated On 08/27/2012, Published on 07/21/2015