Clinical and public health implications of glycemic relapse in type 2 diabetes

Patrick J O'Connor* and JoAnn Sperl-Hillen

This article has no abstract so we have provided the first paragraph of the full text.

There is ample evidence that the overall quality of diabetes care in the US is unsatisfactory—so much so that in patients with diabetes, the mean HbA_1c level did not improve at all from 1988 to 2002.¹ Graber et al. suggest that glycemic relapse might be a major, unrecognized barrier to desired improvements in HbA_1c levels. Data from other sources are consistent with this hypothesis. The Epidemiology of Diabetes Interventions and Complications (EDIC) study and the UK Prospective Diabetes Study (UKPDS) clearly showed glycemic relapse; by year 9 of the UKPDS, only about 25% of the intensive-treatment group patients had maintained HbA_1c levels of <7%.² High rates of glycemic relapse have also been documented in primary-care settings. In several cohorts in Minnesota with a median HbA_1c level of 6.9% in 2003,³ about 27% of the patients with a baseline HbA_1c level <7% relapse to an HbA_1c level 7% each year.⁴ In aggregate, these data indicate that efforts to improve diabetes care are seriously compromised by a sizable glycemic relapse vector. Moreover, relapse of blood pressure control and lipid control are also recognized problems.

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