BLOOD SUGAR CONTROL--STRATEGY TO IMPROVE CONTROL IN IDDM

血糖控制——改善 IDDM 控制的策略

• 批准号: 6484169
• 负责人: George S Rust
• 金额: $ 7.09万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-01 至 2002-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6484169
• 关键词: African American; blood chemistry; blood glucose; clinical research; clinical trials; community health services; diabetes mellitus therapy; disease /disorder prevention /control; health care policy; health care service evaluation; health insurance; hemoglobin As; human subject; human therapy evaluation; hyperglycemia; insulin dependent diabetes mellitus; low socioeconomic status; outcomes research; patient care management

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.

研究目的：证明医师更有可能加强对不受控制的2型糖尿病的管理，并在使用办公室内血红蛋白分析仪立即获得血红蛋白A1C水平时获得更高的血糖控制率。主要假设：办公室血红蛋白A1C分析仪的立即反馈将A）显着提高医生决定加强糖尿病治疗的速度，并指出2型型糖尿病的患者；并且，b）显着提高此类患者达到的血糖控制水平。研究设计：小组控制试验。人口和抽样框架：该研究将包括佐治亚州亚特兰大的联邦资助的社区健康中心，由初级保健临床医生提供的低收入，少数群体和未保险的患者。将包括2型糖尿病的成年患者。干预方法：我们将测试在医生看到患者之前实施常规订单，以便护士立即进行HGBA1 C测试（就像大多数中心现在进行手指钉随机血糖测试一样，作为测量糖尿病患者常规生命体征的一部分），并通过提供设备（Bayer DCA-2000）和提供此站立订单。治疗的加强将通过医疗记录中的证据来确定医疗方案（药物，剂量或时间表）或营养学家转诊的证据。结果指标：（1）与在3个用作对照部位的3个卫星诊所发生变化后，干预部位的治疗率（干预前后）的加强率变化； （2）与对照部位相比，干预部位的HGB A1C的平均值之前变化。