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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)

Percentage of Respondents With Diabetes Who Had at Least Two Hemoglobin A1c Tests in the Past 12 Months, Utah and U.S. 2000-2006

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.   Rates are age-adjusted and standardized to 2000 U.S. population.

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS)

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.

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.

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 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 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 www.yourdiabetesinfo.org

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.
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 Tue, 04 August 2015 9:51:35 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, 6 Feb 2015 11:52:49 MST