Looking Beyond A1C as the Gold Standard in Diabetes Outcomes
Time and place
5:00 pm – 6:00 pm
Friday | Room 6B
About the presenter:
Dr. Vigersky, former president of the Endocrine Society and Director Emeritus of the Diabetes Institute at the Walter Reed National Military Medical Center, is medical director for Medtronic Diabetes. He has focused on the use of technology and decision-support systems to improve outcomes for patients with diabetes and has been interested in developing a composite metric for at least 10 years.
“It became obvious that we weren’t able to capture the benefit of a lot of interventions just based on A1C,” he said, noting the necessity of looking at multiple metrics to determine how the intervention is working in specific patients. “I finally thought, ‘We’ve been talking about this for a long time, somebody has got to come up with a single metric that describes overall glycemic control.’”
For more than 30 years, the diabetes community has relied on A1C as the key metric in assessing overall glycemic control and the effect of any intervention, but most researchers and clinicians recognize that A1C insufficiently captures the quality of glycemic control.
“A1C only tells part of the story because all it does is represent an average glucose,” said Dr. Vigersky. “One can have a very good average, but be in terrible control because of lots of highs and lots of lows.”
Most diabetologists and educators recognize that there has been increasing enthusiasm to transition from using A1C alone to A1C plus other metrics, called a composite metric, that better describe what’s going on with a patient’s glycemic control. A1C, rate/severity of hypoglycemia, weight change, cost, patient satisfaction and blood pressure change are among the clinically relevant variables that should be included in a composite score.
“I’m going to describe alternate metrics, which I believe better represent what is going on with the patient’s control,” said Dr. Vigersky.
Why this matters to AADE16 attendees:
“Diabetes educators are the key individuals in helping patients understand what their glycemic control actually is,” said Dr. Vigersky, so the educator needs a broader picture of what’s going on with patient than the A1C can provide.
A1C is not enough. Diabetes educators need to understand that metrics available on reports generated from either self-monitoring of blood glucose by finger stick or by continuous glucose monitoring will help them better understand their patients’ glycemic control.
“They will be better able to read the emerging literature in which clinical trials will begin describing the results of their intervention in more specific terms so that it won’t just be A1C, it will be these other metrics I mentioned,” said Dr. Vigersky.
Also of note:
The advantages and disadvantage of composite endpoints, including the glucose pentagon, the Q-score, and the hypoglycemia-A1C score, will be discussed during the session. “I am going to show some new data from trials in patients with type 1 diabetes that will be analyzed according to the old metrics versus new composite metrics,” said Dr. Vigersky.