Diabetes: HbA1c Control (<8%) (NQF 0575)

eMeasure Name Diabetes: HbA1c Control (<8%) eMeasure Id b2779a23-88b3-45ff-9514-56606bf916d9
Version number 1 eMeasure Set Id 6a7c5424-16bb-4bf1-89bb-7b80d2b87aab
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had HbA1c <8.0%.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who demonstrate adequate blood sugar control with an HbA1c level lower than 8 percent. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life-threatening, life-ending or life-altering complications, including poor blood sugar control. Studies have shown that improved glycemic control is correlated with a 40% decline in the development of associated microvascular complications (i.e., eye, kidney and nerve diseases)( ADA 2009). Clinical guidelines recommend regular HbA1c testing to facilitate patients ability to improve and sustain acceptable levels (ADA 2009). This measure facilitates the maintenance and long-term management of adequate blood sugar levels for patients diagnosed with diabetes.
Clinical Recommendation Statement
American Geriatric Society:
                
[1]For frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as 8% is appropriate. (Level III, Grade B)

[2]For older persons, target hemoglobin A1C should be individualized. A reasonable goal for A1C in relatively healthy adults with good functional status is 7% or lower. (Level III, Grade B)

American Diabetes Association:

[1]Lowering A1C to below or around 7% has been shown to reduce microvascular and neuropathic complications of type 1 and type 2 diabetes. Therefore, for microvascular disease prevention, the A1C goal for nonpregnant adults in general is <7%. (A)

[2]In type 1 and type 2 diabetes, randomized controlled trials of intensive versus standard glycemic control have not shown a significant reduction in CVD outcomes during the randomized portion of the trials. Long-term follow-up of the Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) cohorts suggests that treatment to A1C targets below or around 7% in the years soon after the diagnosis of diabetes is associated with long-term reduction in risk of macrovascular disease. Until more evidence becomes available, the general goal of <7% appears reasonable for many adults for macrovascular risk reduction. (B)

[3]Subgroup analyses of clinical trials such as the DCCT and UKPDS and the microvascular evidence from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial suggest a small but incremental benefit in microvascular outcomes with A1C values closer to normal. Therefore, for selected individual patients, providers might reasonably suggest even lower A1C goals than the general goal of <7%, if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Such patients might include those with short duration of diabetes, long life expectancy, and no significant CVD. (B)

[4]Conversely, less stringent A1C goals than the general goal of <7% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, and extensive comorbid conditions and those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose lowering agents including insulin. (C )
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Guidelines for Improving the Care of the Older Person with Diabetes Mellitus. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. American Geriatrics Society. May 2003 - Vol. 51, No. 5 Supplement, JAGS.
Reference
Standards of Medical Care in Diabetes - 2009. Diabetes Care January 2009 32:S6-S12; doi: 10.2337/dc09-S006
Definition
Initial Patient Population(s): All patients 18 to 75 years of age during the measurement period
Definition
Denominator(s): Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period
Definition
Denominator Exclusion(s): Patients with a diagnosis of polycystic ovaries, gestational diabetes or steroid-induced diabetes who did not have any face-to-face encounters in any setting, with a diagnosis of diabetes, during the measurement period or the 12 months prior to the measurement period.
Definition
Numerator(s): The number of patients whose most recent automated HbA1c level is <8.0%
Definition
Denominator Exception(s): N/A
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012