Volume 1, Number 3
Diabetes and A1C
Diabetes mellitus (DM), or simply diabetes, is a group of diseases in which a
person has high blood sugar. This high blood sugar causes the person to have
frequent urination, increased thirst, and increased hunger. Diabetes can cause
many complications, including heart disease, kidney failure, damage to the eyes,
and poor circulation to the feet resulting in ulcers and/or amputation.
Diabetes is due to either the pancreas not making enough insulin or because cells
in the body do not respond properly to the insulin that is made. There are three
main types of diabetes mellitus:



Diabetes Type 1 results from the body's failure to produce insulin. This form
was previously referred to as "insulin dependent diabetes mellitus" (IDDM) or
"juvenile diabetes".
Diabetes Type 2 results from insulin resistance, a condition in which cells fail to
use insulin properly, sometimes also with a lack of insulin. This form was
previously referred to as non-insulin dependent diabetes mellitus (NIDDM) or
"adult-onset diabetes".
Gestational diabetes is the third main form and occurs when a woman without
a previous diagnosis of diabetes develops a high blood sugar level during
pregnancy.
Prevention and treatment usually involve: a healthy diet, physical exercise, not
using tobacco, and being a normal body weight. Blood pressure control and
proper foot care are also important. Type 1 diabetes must be treated with insulin
injections. Type 2 diabetes may be treated with oral medications and/or insulin
injections. Gestational diabetes is treated with diet, exercise, and insulin
injections and/or oral medications, and usually resolves after birth of baby.
Globally, as of 2010, an estimated 250 million people have diabetes, with Type 2
making up about 90% of the cases. This is equal to 3.3% of the world’s population
with equal rates in both women and men. In 2011, diabetes resulted in 1.4 million
deaths worldwide making it the 8th leading cause of death. At HDI, we care for
more than 3000 diabetic patients, about 10% of our total medical patient
population.
Volume 1, Number 3
Because diabetes is widespread and can result in many complications, it has been
designated as one of HDI’s ‘high risk’ patient populations. This means that we are
working with our diabetic patients to help them be as healthy as possible, with
the fewest number of complications. Blood sugar control is key to managing
diabetes. Patients regularly monitor blood sugar levels at home and we do an A1C
test every 3 – 6 months in the office to monitor blood sugar over time. The A1C
tells the “doctor” what the patient’s blood sugar levels have been over the past 3
months. At HDI, our goal is for our patients to have an A1C less than or equal to 9
to be considered “controlled.” For “good control,” an A1C less than 7 is preferred.
HDI looks at the care being given to all of our diabetic patients throughout the
year. Each “doctor” is given information about how he/she is doing compared to
other “doctors” at HDI. This graph shows the average A1C levels of our patients
by site. Goal is 80%, current average at HDI is 77%.
A1C < OR = 9
100%
80%
77%
82%
Goal
Bayside
Bridgeport
78%
66%
75%
79%
Janes
Ruffin
79%
77%
50%
0%
DRG
*Imlay City
Shiawassee Average
Call to Action: If you have diabetes, when was your last A1C done? What was the
result? Is there something you can do to lower that number – perhaps making
healthier choices when eating or increasing the amount of physical activity that
you do or being sure to take your medications every day? And, to minimize
complications from diabetes, in the past year, have you had an eye exam? Have
you had your cholesterol and kidney function checked? At every visit, have you
taken off your shoes and socks so the “doctor” can check your feet?
HDI is committed to providing “Quality Healthcare for Everyone.” Look for more
information about our quality projects and PCMH in future editions of HDI
Quality Insider. If you have questions, please talk to any member of our staff.