For U.S. Healthcare Professionals Only



Why are nearly 1 in 2 patients with T2DM still not reaching the ADA-recommended HbA1c target?*

Despite the increased availability of resources, education, and treatments, the percentage of patients who are not well controlled (HbA1c ≥7.0%) remains high1-3,*

  • Approximately 40 treatments for T2DM have become available since 20002,3,†
  • About 47.8% of the 21 million Americans diagnosed with diabetes4approximately 10 million non-pregnant adult patients—are still not reaching the ADA’s general HbA1c target of <7.0%.1,4,5,*

Study Design: This retrospective analysis used survey and blood test data from NHANES collected from 1999 through 2010. Records from 3355 patients who had received a diagnosis of diabetes from a healthcare provider were included. NHANES uses stratified, multistage, probability-cluster techniques to ensure that the survey data collected are from a representative patient sampling. Analyses were confined to persons with a self-reported diagnosis of diabetes. Study Limitations: Recall and social-desirability bias are inherent limitations of self-reported data.1

*For non-pregnant healthy adults, the ADA recommends an HbA1c target of <7.0%. However, HbA1c targets are individualized for each patient.5

As of December 2016.

In actual clinical practice, treatment intensification occurs long after ADA guidelines recommend

  • Guidelines by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend healthy eating, weight control, increased physical activity, and diabetes education as a foundation for T2DM management throughout the course of treatment.5,6
  • ADA guidelines recommend titrating or adding therapies every 3 months in patients who are not reaching their glycemic target5
  • However, a large cohort study found that treatment intensification doesn’t always follow recommended practice7
    • In patients uncontrolled on 1 OAD, the addition of another OAD took 1.6 to 2.9 years
    • In patients uncontrolled on 3 OADs, insulin was introduced 6-7 years after the time poor glycemic control was identified (HbA1c ≥7.0%)

Study Design: A Clinical Practice Research Datalink (CPRD) retrospective database cohort analysis of patients (N=5677) with T2DM uncontrolled on 3 OADs, with HbA1c ≥8.0%, evaluated median time to add insulin from January 2004 to December 2006. Mean HbA1c reached 9.0% at the time of treatment escalation. CPRD is the world’s largest computerized database of its kind, comprising primary care records of >13 million patients in the United Kingdom. Although there are some limitations to the study with regard to patient characteristics and drug intensification, the database can be considered a representative sample.7

AACE=American Association of Clinical Endocrinologists; ADA=American Diabetes Association; HbA1c=glycated hemoglobin; NHANES=National Health and Nutrition Examination Survey; OADs=oral antidiabetics; T2DM=type 2 diabetes mellitus

Could you do more to help your patients who aren’t reaching their individualized glycemic target?


1.Ali MK, Bullard KM, Saaddine JB, et al. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med. 2013;368:1613-1624. doi:10.1056/NEJMsa1213829. 2.US Food and Drug Administration. FDA-approved diabetes medicines. Accessed January 17, 2017.3. 2016 FDA Approved Drugs. CenterWatch. Accessed January 17, 2017. 4. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. 5. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2016;39(Suppl.1):S1-S112. 6. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2016 executive summary. Endocr Pract. 2016;22(1):84-113. 7. Khunti K, Wolden ML, Thorsted BL, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36(11):3411-3417. doi:10.2337/dc13-0331.