Perceptions of HbA 1c in people with diabetes: A barrier to improving control?

As a backdrop to the IMPROVE™ Control campaign, in this issue we bring you illuminating results from a recent survey of people with diabetes receiving insulin therapy. The survey, which was commissioned by Novo Nordisk, explored the respondents’ attitudes toward information provision and their knowledge of HbA_1c, with results for the latter being particularly enlightening.

Survey results
Overall, 10500 people with diabetes were invited to participate by mail in July and August 2008, and 3750 responses were analysed. Alarmingly, the data revealed that more than one-third of the people surveyed had not heard of the term “HbA_1c” (Figure 1). Given this, it is not surprising that only half of the respondents reported that they know what HbA_1c measures (Figure 2), and more than half of those surveyed did not know their current HbA_1c level (Figure 3). Of those who did know their HbA_1c, 52% reported a level that was ≤7.5%.

Clinical implications
One of the key messages from NICE’s 2008 guideline on the management of type 2 diabetes is that people with diabetes should be involved in making decisions about their target HbA1c level (National Collaborating Centre for Chronic Conditions [NCCCC], 2008).

Furthermore, professionals were advised to “encourage the person to maintain their individual target unless the resulting side effects (including hypoglycaemia) or their efforts to achieve this impair their quality of life” (NCCCC, 2008).

The result that a substantial proportion of respondents in this survey reported that they have not heard of the term HbA_1c, that they do not know what HbA_1c represents, or that they do not know their current HbA_1c level, may not be surprising to healthcare professionals working with people with diabetes. However, given NICE’s recommendations, these findings seem to be symptomatic of a key barrier to improving glycaemic control; there is clearly much work still to be done.