Letter to the Editor: Challenges in Diabetes Mellitus Management: Important Lesson From Early HbA1c Trends

Abstract

To the Editor We read with interest the article by Kim et al.1 on the long-term control of diabetes mellitus (DM) after visiting a tertiary university hospital. In this study, patients were categorized into 4 groups based on HbA1c changes at three months; Best (≥ 1.6% decrease), Better (0.5-1.5% reduction), Neutral (≤ 0.4% decrease or ≤ 0.4% increase), and Worst (≥ 0.5% increase). The Best group had the best control up to 7 years, regardless of the baseline Hba1c. The groups with improvement (Best and Better) had lower risk for complications (cardiac and cerebrovascular), albeit not significant. This study provided important guides for target HbA1c reductions within 3, if not 12 months (no data on 3-month HbA1c reported). The accompanying editorial stressed on this and highlighted the benefits of the ‘legacy effects’, and alluded to factors that contribute to poor control that included beta cell dysfunctions, inconsistencies with guidelines and practices, and clinical inertia especially in the primary care settings.2 Treatment at primary and even secondary care levels are usually a bottom-up approach (stepwise increase in medications) and there also may be clinical inertia on part of doctors to introduce or escalate, including use of insulin, mainly for fear of inducing hypoglycemia and patient’s reluctance to accept treatment modifications