BLOOD SUGAR CONTROL--STRATEGY TO IMPROVE CONTROL IN IDDM

研究目的：为了证明医生更有可能加强对未控制的2型糖尿病的管理，当使用办公室内的血红蛋白分析仪立即获得血红蛋白A1C水平时，更有可能实现更高的血糖控制率。基本假设：来自办公室内的血红蛋白A1C分析仪的即时反馈将a)显著提高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；以及b)显著改善这类患者的血糖控制水平。研究设计：分组对照试验。人口和抽样框架：这项研究将包括由佐治亚州亚特兰大一家联邦资助的社区卫生中心的初级保健临床医生提供服务的低收入、少数族裔和未参保的患者。成年2型糖尿病患者将被包括在内。干预方法：我们将测试实施常规命令的效果，即护士在医生看到患者之前立即进行HgbA1-C测试(就像大多数中心现在将手指滴答随机血糖测试作为测量糖尿病患者常规生命体征的一部分)，并通过提供执行这一常规命令所需的设备(拜耳DCA-2000)和用品来测试其效果。强化治疗将由医疗记录中记录的改变医疗方案(药物、剂量或时间表)或营养师转介的证据来确定。观察指标：(1)作为对照的3家卫星诊所干预前后治疗强化速率的变化；(2)干预前后Hgb-A1C均值的变化。

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.