Examples from EUCID data: HbA1c and cholesterol levels in diabetics

This section focuses on data collected on biomedical risk facors in diabetics. In total, twelve indicators are included in this EUCID category:

• HbA1c tested
• HbA1c > 7.0 %
• Cholesterol tested
• Cholesterol > 5 mmol/l
• LDL-Cholesterol tested
• LDL-Cholesterol > 2.6 mmol/l
• HDL-Cholesterol tested
• HDL-Cholesterol <1.0 men and <1.25 women
• Triglycerides tested
• Triglycerides < 2.3 mmol/l
• Albuminuria tested
• Albuminuria abnormal

All of these biomedical factors have a well defined normal value and a cut off point where intervention is agreed upon. The consensus is that all of these risk factors should be measured at least annually. Most of the data originated from clinical databases, as national or regional samples that were more or less representative for the national population. The complete set of indicators can be found in the final report of the EUCID project.

Most of the European countries achieve remarkably good testing levels of people with diabetes. However some data originates from databases that might not reflect the average situation in the countries.

In general, the variation of risk factor and outcome levels across countries reflect a mixture of genetic background, societal and cultural factors, as well as public health policies, in combination with the quality and organization of local health care.

As examples for EUPHIX, data are reproduced on the proportion of the diabetics tested that showed elevated levels of HbA1c (>7.0%) or total cholesterol (> 5 mmol/l).

Among diabetics tested the percentage with HbA1c > 7% ranges from 32% to 83%

It is important for diabetes patients to reach an optimal blood glucose level, both for their general well being and to minimise the risk of micro-vascular complications. In non-diabetics, the protein HbA1c ranges from 4 to 6%. Its level reflects the average blood glucose during the last 8 to 12 weeks and is therefore a good marker for the appropriate regulation of blood glucose . Most guidelines recommend that diabetics maintain an HbA1c level below 7%, although some even recommend a threshold as low as 6.5%.

A related set of data from EUCID shows that between 51% (Ireland) and 99% (several countries) of diabetics are regularly tested for their HbA1c levels.

For the data on the present indicator, see HbA1c>7.0% in diabetic population aged >25. 11 Countries were able to provide these data for the EUCID project. The percentage of the diabetic population that did not achieve the 7% goal differs considerably between countries: in Ireland 32% did not achieve this goal versus 83% in Cyprus.

Among diabetics tested the percentage with a total cholesterol of >5 mmol/l ranged between 14% and 68%

There is much discussion about the best way to specify the risk of enhanced cholesterol levels for macro-vascular disease. A total cholesterol level above 5.0 mmol/l is, however, acknowledged by many guidelines as a screening target. The majority of diabetics who receive pharmacological treatment can reach this target.

A related set of data from EUCID shows that between 45% (Ireland) and 99% (the Netherlands) of diabetics are regularly tested for their total cholesterol levels.

For the data on the present indicator, see Cholesterol > 5 mmol/l in diabetic population aged >25. 12 Countries were able to provide these data for the EUCID project. The percentage of the diabetic population that did not achieve the 5 mmol/l goal differs considerably between countries: in Ireland and Sweden 14% did not achieve this goal versus 68% in Cyprus.