BLOOD SUGAR CONTROL--STRATEGY TO IMPROVE CONTROL IN IDDM

研究目的：证明医生更有可能加强对不受控制的2型糖尿病的管理，并在使用办公室血红蛋白分析仪立即获得血红蛋白A1 C水平时实现更高的血糖控制率。主要假设：来自办公室血红蛋白A1 C分析仪的即时反馈将a）显著增加医生决定在患有不受控制的2型糖尿病的患者中进行强化糖尿病治疗的比率;和，B）显著改善在这些患者中实现的血糖控制水平。研究设计：分组对照试验。总体和抽样框架：这项研究将包括低收入，少数民族和无保险的患者，他们由格鲁吉亚亚特兰大市联邦资助的社区卫生中心的初级保健医生提供服务。将纳入2型糖尿病成人患者。干预方法：我们将测试实施护士在患者被医生看到之前立即进行HgbA 1 C测试的长期订单的效果（就像大多数中心现在进行手指滴答随机血糖测试作为糖尿病患者常规生命体征测量的一部分），并通过提供执行此长期订单所需的设备（Bayer DCA-2000）和用品。强化治疗将根据医疗记录中的医疗方案（药物、剂量或时间表）变更或营养师转诊的书面证据确定。结局指标：（1）干预中心强化治疗率（干预前后）与作为对照中心的3个卫星诊所变化前后相比的变化;（2）干预中心与对照中心Hgb A1 C平均值的变化前后。

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.