Most chronic diseases don’t have an easily definable beginning point. Children’s personalities vary widely from quiet and focused to rambunctious and distractible. At what point do we say they have ADHD? There is an association between higher blood pressures and higher stroke and heart attack rates across a wide spectrum of pressures. At what point do we define hypertension?
An article in JAMA reminds us of how rapidly the hemoglobin A1c definition of good diabetes control has fallen over the last decade. From 9.5% to 9.0% in the early 2000s, down to 7.0% as early as 2004; pushed in part by the National Committee for Quality Assurance (NCQA). Of course it was the endocrinologists who led the charge to 7.0% based solely on theory and observational evidence, with some drug company urging in the background
Then along comes the ACCORD trial in 2008 showing that diabetics were more likely to die in this drive to “normalize” blood glucose values below 7.0%. Once again, GIMeC assumed more drugs led to better health, but they didn’t. Just because a diabetic with a hemoglobin A1c of 7.5% on no medications has a better quality of life than a diabetic whose A1c is 10%, doesn’t mean that pushing the A1c value down with medications gives the same outcome.
The writers of the commentary noted the waste of scarce healthcare dollars caused by this premature standard and said, “This case study indicates that the quality industry’s process of developing performance measures is broken and that steps need to be taken to restore accountability.” I couldn’t have said it better myself.