Diabetes Mellitus Management 'PENTAD'
Frank Lawler, MD
The University of Oklahoma Oklahoma City
Arch Fam Med. 1994;3(11):943-944.
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While laud the efforts of Lardinois and Lougaris1 to improve diabetes control, I must express strong disagreement of the use of hemoglobin A1c as a quality measure. I have quite a number of diabetics in my patient population; several of them routinely have fasting glucose levels between 13.9 and 16.6 mmol/L (250 and 300 mg/dL) because of a conscious choice of a lifestyle. Others faithfully check and record their glucose levels twice a day.
In both of these groups, the measurement of hemoglobin A1c adds nothing to the management of their disease but another test and bill. Simply ordering a test to be in compliance with poorly conceived guidelines is one of the worst aspects of a bureaucratic approach to medicine. To say that compliance of "less than 100% is unacceptable" is ludicrous. I hope this is not the future of health care system reform.
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