Rapid A1c availability improves clinical decision-making in an urban primary care clinic
Rapid A1c availability improves clinical decision-making in an urban primary care clinic
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DOI：
10.2337/diacare.26.4.1158
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发表时间：
2003-04-01
期刊：
影响因子：
16.2
通讯作者：
El-Kebbi, IM
中科院分区：
文献类型：
--
作者：
Miller, CD;Barnes, CS;El-Kebbi, IM
目的：在初级保健环境中未能达到血糖控制目标的部分原因可能是缺乏指导强化治疗的关键信息。我们的目标是确定A1c的快速周转是否将改善糖尿病治疗的强度并降低2型糖尿病患者的ALE水平。研究设计和方法-在这项前瞻性对照试验中，ALE是在毛细血管血糖样本上确定的，并在患者就诊期间(“快速”)或(“常规”)之后提供给提供者。结果：我们招募了597名受试者，并在基线和随访后评估了控制不充分的患者强化药物治疗糖尿病的频率和A1c水平。患者中79%为女性，96%为非裔美国人，平均年龄61岁，糖尿病病程10年，体重指数33 kg/m(2)，糖化血红蛋白8.5%。快速组和常规组的临床人口学特征相似。当基线就诊时ALE大于或等于7.0%(51vs.32%，P=0.01)，尤其是当ALE为8.0%和/或随机血糖在8.4-14.4 mmol/L范围(151-250 mg/dl)时，A1c的快速可用导致更频繁的强化治疗。在275例有两次随访的患者中，快速组ALE显著下降(从8.4%降至8.1%，P=0.04)，而常规组则无明显下降(从8.1%降至8.0%，P=0.31)。结论在城市社区卫生中心，快速A1c测量增加了2型糖尿病患者强化治疗的频率，降低了A1c水平。
OBJECTIVE - Failure to meet goals for glycemic control in primary care settings may be due in part to lack of information critical to guide intensification of therapy. Our objective is to determine whether rapid-turnaround A1c availability would improve intensification of diabetes therapy and reduce Ale levels in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS - in this prospective controlled trial, Ale was determined on capillary glucose samples and made available to providers, either during ("rapid") or after ("routine") the patient visit. Frequency of intensification of pharmacological diabetes therapy in inadequately controlled patients and A1c levels were assessed at baseline and after follow-up.RESULTS - We recruited 597 subjects. Patients were 79% female and 96% African American, with average age of 61 years, duration of diabetes 10 years, BMI 33 kg/m(2), and A1c 8.5%. The rapid and routine groups had similar clinical demographics. Rapid A1c availability resulted in more frequent intensification of therapy when Ale was greater than or equal to7.0% at the baseline visit (51 vs. 32% of patients, P = 0.01), particularly when Ale was >8.0% and/or random glucose was in the 8.4-14.4 mmol/l range (151-250 mg/dl). In 275 patients with two follow-up visits, Ale fell significantly in the rapid group (from 8.4 to 8.1%, P = 0.04) but not in the routine group (from 8.1 to 8.0%, P = 0.31).CONCLUSIONS - Availability of rapid A1c measurements increased the frequency of intensification of therapy and lowered A1c levels in patients with type 2 diabetes in an urban neighborhood health center.