Response to Iqbal et al. Ann Clin Biochem 2008;45 :504–7

Dear Editor,

Iqbal et al. ¹ have assessed the impact of improving knowledge of the HbA_1c test on the glycaemic control of patients with type 1 and type 2 diabetes. They found that an educational intervention led to a significant reduction in percentage HbA_1c. This fall was marked in patients with poor glycaemic control (HbA_1c > 9%) and especially so in those who were also unfamiliar with the term HbA_1c. The report coincides with the recent release of United Kingdom Perspective Diabetes Study (UKPDS) 10-year follow-up data, which provides compelling evidence that good glycaemic control can reduce the long-term risk of both micro- and macrovascular complications associated with type 2 diabetes. ²

The Global Task Force (GTF) on Glycaemic Control was established in 2006 with the aim of providing practical solutions to the problem of poor glycaemic control in type 2 diabetes. A first step of the GTF was to review a global survey evaluating HbA_1c awareness, attitudes and behaviours among health-care professionals (HCPs) and patients in China, Canada, India, Poland, Russia, Sweden, Turkey and the UK.

It was found that knowledge of HbA_1c was generally low among patients, but ranged from 28% in India and 33% in Poland up to 64% in China and 92% in Sweden. ³ The UK was behind Sweden and China at 62%. Our survey, therefore, corroborates the findings of Iqbal et al. while their study also shows that improved patient education can lead to an improvement in glycaemia.

In response to these findings, the GTF, in collaboration with Novo Nordisk, have developed an educational toolkit focusing on educating HCPs on the importance of glycaemic control (as assessed by measures such as HbA_1c) and providing the latest knowledge, skills and tools to help them to train their peers and colleagues and ultimately help improve glycaemic control in patients with type 2 diabetes.

Consisting of three modules, the first module in the Improve Control Education Toolkit outlines treatment options and glycaemic guidelines, and how best to use these guidelines to effectively manage a patient through different stages of their disease. Module two tackles patient barriers to good glycaemic control through psychosocial and effective communication strategies, while the final module consists of case-based learning to put the knowledge gained from the first two modules into a practical context.

It is worrying that it is in some of the countries where the diabetes pandemic is likely to feature most highly (such as India) that the knowledge of HbA_1c is at its lowest. It is hoped that initiatives, such as the Improve Control Education Toolkit, will help bridge the gap identified by Iqbal et al. between knowledge of glycaemic control (including its markers) and implementing measures that can help HCPs and patients to improve it.

Declaration of competing interests: Eric Kilpatrick has received remuneration from Novo Nordisk for time spent in developing the GTF project.