Diabetes Mellitus

Type 2 diabetes is a metabolic disease characterized by high blood glucose levels due to insulin resistance in body tissues such as muscle and fat, in conjunction with insufficient insulin levels and overproduction of glucose by the liver. Globally, there has been a continuous rise in the prevalence of diabetes, and it is considered one of the most significant public health emergencies of the 21st century. Compared to 1980, the number of people aged 20–79 with diabetes has nearly quadrupled, and it is currently estimated that around 425 million people worldwide are living with the disease, with a global prevalence rate of 8.8% (1). Diabetes prevalence rates increase with age and are slightly higher in men compared to women. According to the latest national health survey, the prevalence of diabetes among the adult population in Israel is 8.4% (8.8% in men, 8.0% in women) (2).If current trends in population growth and diabetes incidence in Israel continue, it is estimated that by the year 2030, there will be 1,200,000 people with diabetes in the country. In 2016, diabetes and its complications accounted for 5.2% of all deaths in Israel (2,291 cases), ranking it as the fourth leading cause of mortality after malignant neoplasms, cardiovascular diseases, and infectious diseases (3). Diabetes treatment focuses on achieving metabolic control of glucose levels and preventing complications and damage to key target organs, including the heart, kidneys, eyes, and limbs. Measurement of glycated hemoglobin (HbA1c) is a widely used tool for assessing the effectiveness of diabetes treatment, as it reflects average blood glucose levels over the preceding 2–3 months and is a strong predictor of diabetes-related complications (4,5). The American Diabetes Association (ADA) recommends performing the HbA1c test twice a year for patients with stable and well-controlled diabetes, and every three months for patients with poor glycemic control or following changes in treatment (6).
Studies have shown that tight blood glucose control reduces the risk of developing microvascular complications of diabetes, however, it is less effective in preventing macrovascular complications. Moreover, attempts to achieve stricter glycemic control have been associated with an increased risk of hypoglycemia and its consequences, particularly among older adults, individuals with long-standing diabetes, and those already suffering from diabetic complications (7–9). Over the years, there has been a growing trend toward personalizing glycemic targets and increasing efforts to tailor treatments to the specific needs of each patient (10). Quality indicators for glycemic control define two different HbA1c target levels (7% or 8%) depending on the patient’s age and duration of diabetes diagnosis, as well as poor glycemic control- HbA1c level above 9%.
Diabetes treatment focuses on achieving metabolic control of glucose levels and preventing complications and damage to key target organs, including the heart, kidneys, eyes, and limbs. Measurement of glycated hemoglobin (HbA1c) is a widely used tool for assessing the effectiveness of diabetes treatment, as it reflects average blood glucose levels over the preceding 2–3 months and is a strong predictor of diabetes-related complications (4,5). The American Diabetes Association (ADA) recommends performing the HbA1c test twice a year for patients with stable and well-controlled diabetes, and every three months for patients with poor glycemic control or following changes in treatment (6).
Studies have shown that tight blood glucose control reduces the risk of developing microvascular complications of diabetes, however, it is less effective in preventing macrovascular complications. Moreover, attempts to achieve stricter glycemic control have been associated with an increased risk of hypoglycemia and its consequences, particularly among older adults, individuals with long-standing diabetes, and those already suffering from diabetic complications (7–9). Over the years, there has been a growing trend toward personalizing glycemic targets and increasing efforts to tailor treatments to the specific needs of each patient (10). Quality indicators for glycemic control define two different HbA1c target levels (7% or 8%) depending on the patient’s age and duration of diabetes diagnosis, as well as poor glycemic control- HbA1c level above 9%.

Note: This morbidity index defines the denominator population of many of the quality of medical care indicators for adult diabetic patients.