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.
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 the following [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf link].
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 [http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s15#T7 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.
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 [https://ibis.health.utah.gov/ibisph-view/indicator/view/HEDISHbA1c.html 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.
How Do We Compare With the U.S.?The 2019 age-adjusted rate for Utah is higher than that for the U.S., 70.2% vs. 69.2%, respectively. However, the U.S. data only includes 24 states.
What Is Being Done?A public service announcement from the Utah Department of Health regarding A1C testing, [https://www.youtube.com/watch?v=vWJkgo8XYNc "Do you wish you could reverse time?"] is available for view in English and Spanish.
Diabetes educators play a prominent role in providing information about nutrition, exercise, and blood glucose monitoring. Diabetes education for all people with diabetes is encouraged.
The Healthy Environments Active Living (HEAL) program encourages people with diabetes to enroll in a diabetes self-management education class. These classes have been shown to help individuals develop the skills they need to manage their diabetes and are usually taught by dietitians, nurses, or pharmacists, who may also hold the status of Certified Diabetes Educator (CDE). CDEs have considerable expertise in diabetes management and understand what the individual with diabetes is going through.
The Utah Arthritis Program supports Chronic Disease Self-Management Programs and Diabetes Self-Management Programs throughout the state, this program is also called the Living Well with Chronic Conditions Program. This six-week program is available throughout the state at no cost and taught by community members. Information is available from Nichole Shepard, 801-538-6259, firstname.lastname@example.org. More information is available on the [http://livingwell.utah.gov/ Living Well Utah website].
The HEAL program is working statewide to increase the number of locations that offer DSME and also promote DSME to eligible participants.
The National DPP is also an evidence-based program to prevent type 2 diabetes. The HEAL program works with statewide partners to promote the National DPP to eligible Utahns and also is working to expand National DPP sites across the state.
Evidence-based PracticesDiabetes Self-Management Education and Support ([https://www.cdc.gov/diabetes/managing/education.html DSMES]) has been shown to improve blood glucose control in people with diabetes. Education programs may be certified by the American Diabetes Association or the Association of Diabetes Educators. Here is a [https://livingwell.utah.gov/program.php?grp=diab list] of DSMES programs available in Utah.
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.
Originally known as EPICC, (The Healthy Living through Environment, Policy, and Improved Clinical Care Program), the Healthy Environments Active Living (HEAL) Program is a program within the Utah Department of Health Bureau of Health Promotion. HEAL focuses on enabling education and engaged change for public health by engaging its three main audiences: individuals, partners, and decision-makers. HEAL champions public health initiatives and addresses the challenges of making health awareness and access truly universal and equitable in eight key areas: nutrition, heart health, diabetes, physical activity, schools, child care, community health workers, and worksites.
The HEAL Program aims to reduce the incidence of diabetes, heart disease, and stroke by targeting risk factors including reducing obesity, increasing physical activity and nutritious food consumption, and improving diabetes and hypertension control.
The primary program strategies include:
*Increasing healthy nutrition and physical activity environments in K-12 schools
*Increasing healthy nutrition and physical activity environments in early care and education (childcare/preschool)
*Increasing healthy nutrition and physical activity environments in worksites
*Improving awareness of prediabetes and hypertension for Utahns
*Improving the quality of medical care for people with diabetes and hypertension
*Improving the linkages between health care providers and supporting community programs for Utahns with diabetes and hypertension
*Improving access and availability to community health programs for Utahns with diabetes, hypertension, and obesity.
*Improving care and management of students with chronic conditions in Utah schools