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Abstract
Objective
The American Diabetes Association (ADA) guidelines recommend A1C testing schedules for patients with type 2 diabetes; however, level of real-world guideline adherence remains unclear. The current study evaluated A1C testing frequency and its association with glycemic control and cardiovascular outcomes.
Methods
A retrospective study was conducted utilizing Aetna’s Enterprise Data Warehouse. Adult patients with a medical claim for type 2 diabetes in 2017 (index date) were included. Patients had continuous enrollment through December 2019 and ≥1 reported A1C measurement from 2017 to 2019. Follow-up was up to 36 months post-index date.
Results
Of the 112,572 eligible patients, 50.0% were female and median age was 70 years; 32.9% of patients with controlled baseline A1C (<8%, 64 mmol/mol) received less than the 2 tests/year recommended by the ADA, while 60.6% of patients with uncontrolled baseline A1C received less than the quarterly testing recommended by the ADA. More frequent testing was associated with age (65–75 years), uncontrolled baseline A1C and presence of comorbidities. In separate multivariable models, 2–3 A1C tests/year were associated with greater likelihood of A1C < 8% (64 mmol/mol) vs. <2 tests/year (OR = 1.07, 95% confidence interval [CI] 1.02–1.12), while >3 tests/year was associated with a modestly increased risk of cardiovascular events vs. <2 tests/year (OR = 1.08, 95% CI 1.01–1.15).
Conclusions
A large proportion of type 2 diabetes patients were not tested per guideline recommendations. The relationship between A1C testing frequency and glycemic control was inconsistent, though there was a significant association between more frequent testing and experiencing a CV event.
Transparency
Declaration of funding
Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA.
Declaration of financial/other relationships
T.W., D.L. and S.R. have disclosed that they are employees and stockholders of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA. A.E. and K.S. have disclosed that they are employees of Healthagen, New York, NY, USA and received research support from Merck & Co. Inc. for the conduct of this study. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. A.E. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Acknowledgements
The authors would like to acknowledge Tongtong Wang PhD of Merck & Co. Inc., Kenilworth, NJ, USA for her contribution to study conception and design. The authors also thank Kristy Iglay PhD MPH of Laylen Scientific Solutions LLC for medical writing assistance.
