BLOOD SUGAR CONTROL--STRATEGY TO IMPROVE CONTROL IN IDDM

研究目的：证明当使用办公室血红蛋白分析仪立即获得糖化血红蛋白水平时，医生更有可能加强对未控制的2型糖尿病的管理，并实现更高的血糖控制率。主要假设：来自办公室血红蛋白A1C分析仪的即时反馈将a)显著增加医生决定在未控制的2型糖尿病患者中加强糖尿病治疗的比率；b)显著提高此类患者的血糖控制水平。研究设计：组对照试验。人口和抽样框架：该研究将包括低收入、少数民族和没有保险的患者，这些患者由佐治亚州亚特兰大联邦资助的社区卫生中心的初级保健临床医生服务。成年2型糖尿病患者将被纳入研究范围。干预方法：我们将测试护士在患者就诊前立即进行hba1c检测（就像大多数中心现在对糖尿病患者进行手指随机血糖检测作为常规生命体征测量的一部分一样）的效果，并通过提供设备（拜耳DCA-2000）和实施这一常规命令所需的用品。强化治疗将根据医疗记录中改变医疗方案（药物、剂量或时间表）的书面证据或营养师转诊来决定。结果测量：(1)干预点治疗强化率（干预前后）与作为对照点的3个卫星诊所治疗强化率变化前后的比较；(2)干预点与对照点Hgb A1C均值前后变化情况。

Research Aim: To demonstrate that physicians are more likely to intensify management of uncontrolled type 2 diabetes and to achieve higher rates of glycemic control when hemoglobin A1C levels are immediately available using an in-office hemoglobin analyzer. Primary Hypotheses: Immediate feedback from an in office hemoglobin A1C analyzer will a) significantly increase the rate in which physicians decide to intensify diabetes therapy when indicated in patients with uncontrolled type 2 diabetes; and, b) significantly improve the level of glycemic control achieved in such patients. Research design: Group-controlled trial. Population & Sampling Frame: The study will include low-income, minority, and uninsured patients served by primary care clinicians at a federally-funded community health center in Atlanta, Georgia. Adult patients with type 2 diabetes will be included. Intervention Methods: We will test the effect of implementing a standing order for nurses to perform an immediate HgbA1 C test before the patient is seen by the doctor (just as most centers now perform a finger-tick random blood glucose test as part of measuring routine vital signs for a diabetic patient), and by providing the equipment (Bayer DCA-2000) and supplies needed to implement this standing order. Intensification of therapy will be determined by documented evidence in the medical record of a change in the medical regimen (drug, dosage, or schedule) or nutritionist referral. Outcome Measures: (1) Change in rate of intensification of therapy (before and after intervention) at intervention site compared to before- after change at 3 satellite clinics used as control sites; (2) Before-after change in mean value of Hgb A1C at intervention site compared to control sites.