Diabetes in urban African-Americans. XVII. Availability of rapid HbA(1c) measurements enhances clinical decision-making

Leonard M. Thaler, David C. Ziemer, Daniel L. Gallina, Curtiss B. Cook, Virginia G. Dunbar, Lawrence S. Phillips, Imad M. El-Kebbi

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE - To assess the impact of rapid-turnaround HbA(1c) results on providers' clinical decision-making and on follow-up HbA(1c) levels. RESEARCH DESIGN AND METHODS - The research design was a randomized clinical trial in which rapid HbA(1c) results were made available to providers on even days of the month (rapid, n = 575), but delayed by 24 h on odd days (conventional, n = 563). Adjustment of therapy for patients with type 2 diabetes was considered appropriate if therapy was intensified for HbA(1c) values >7% or not intensified for HbA(1c) values ≤7%. A post-hoc analysis was also performed using patients (n = 574) who returned for follow-up 2-7 months later to ascertain the effect of rapid HbA(1c) availability on subsequent glycemic control. RESULTS - Rapid HbA(1c) availability resulted in more appropriate management compared with conventional HbA(1c) availability (79 vs. 71%, P = 0.003). This difference was due mainly to less frequent intensification when HbA(1c) levels were ≤7% (10 vs. 22%, P < 0.0001) and slightly to more frequent intensification for patients with HbA(1c) values >7% (67 vs. 63%, P = 0.33). For both groups, intensification was greatest for patients on insulin (51%) compared with patients on oral agents (35%) and diet alone (14%) (P < 0.0001). Regression analysis confirmed that providers receiving conventional HbA(1c) results were more likely to intensify therapy in patients who already had HbA(1c) levels ≤7%. Over 2-7 months of follow- up, HbA(1c) rose more in patients with conventional HbA(1c) results compared with rapid results (0.8 vs. 0.4%, P = 0.02). In patients with initial HbA(1c) >7%, rapid HbA(1c) results had a favorable impact on follow-up HbA(1c) independent of the decision to intensify therapy (P = 0.03). CONCLUSIONS - Availability of rapid HbA(1c) determinations appears to facilitate diabetes management. The more favorable follow-up HbA(1c) profile in the rapid HbA(1c) group occurs independently of the decision to intensify therapy, suggesting the involvement of other factors such as enhanced provider and/or patient motivation.

Original languageEnglish (US)
Pages (from-to)1415-1421
Number of pages7
JournalDiabetes Care
Volume22
Issue number9
DOIs
StatePublished - Sep 1999
Externally publishedYes

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African Americans
Research Design
Therapeutics
Type 2 Diabetes Mellitus
Randomized Controlled Trials
Clinical Decision-Making
Insulin
Diet

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Thaler, L. M., Ziemer, D. C., Gallina, D. L., Cook, C. B., Dunbar, V. G., Phillips, L. S., & El-Kebbi, I. M. (1999). Diabetes in urban African-Americans. XVII. Availability of rapid HbA(1c) measurements enhances clinical decision-making. Diabetes Care, 22(9), 1415-1421. https://doi.org/10.2337/diacare.22.9.1415

Diabetes in urban African-Americans. XVII. Availability of rapid HbA(1c) measurements enhances clinical decision-making. / Thaler, Leonard M.; Ziemer, David C.; Gallina, Daniel L.; Cook, Curtiss B.; Dunbar, Virginia G.; Phillips, Lawrence S.; El-Kebbi, Imad M.

In: Diabetes Care, Vol. 22, No. 9, 09.1999, p. 1415-1421.

Research output: Contribution to journalArticle

Thaler, LM, Ziemer, DC, Gallina, DL, Cook, CB, Dunbar, VG, Phillips, LS & El-Kebbi, IM 1999, 'Diabetes in urban African-Americans. XVII. Availability of rapid HbA(1c) measurements enhances clinical decision-making', Diabetes Care, vol. 22, no. 9, pp. 1415-1421. https://doi.org/10.2337/diacare.22.9.1415
Thaler, Leonard M. ; Ziemer, David C. ; Gallina, Daniel L. ; Cook, Curtiss B. ; Dunbar, Virginia G. ; Phillips, Lawrence S. ; El-Kebbi, Imad M. / Diabetes in urban African-Americans. XVII. Availability of rapid HbA(1c) measurements enhances clinical decision-making. In: Diabetes Care. 1999 ; Vol. 22, No. 9. pp. 1415-1421.
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AU - Thaler, Leonard M.

AU - Ziemer, David C.

AU - Gallina, Daniel L.

AU - Cook, Curtiss B.

AU - Dunbar, Virginia G.

AU - Phillips, Lawrence S.

AU - El-Kebbi, Imad M.

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N2 - OBJECTIVE - To assess the impact of rapid-turnaround HbA(1c) results on providers' clinical decision-making and on follow-up HbA(1c) levels. RESEARCH DESIGN AND METHODS - The research design was a randomized clinical trial in which rapid HbA(1c) results were made available to providers on even days of the month (rapid, n = 575), but delayed by 24 h on odd days (conventional, n = 563). Adjustment of therapy for patients with type 2 diabetes was considered appropriate if therapy was intensified for HbA(1c) values >7% or not intensified for HbA(1c) values ≤7%. A post-hoc analysis was also performed using patients (n = 574) who returned for follow-up 2-7 months later to ascertain the effect of rapid HbA(1c) availability on subsequent glycemic control. RESULTS - Rapid HbA(1c) availability resulted in more appropriate management compared with conventional HbA(1c) availability (79 vs. 71%, P = 0.003). This difference was due mainly to less frequent intensification when HbA(1c) levels were ≤7% (10 vs. 22%, P < 0.0001) and slightly to more frequent intensification for patients with HbA(1c) values >7% (67 vs. 63%, P = 0.33). For both groups, intensification was greatest for patients on insulin (51%) compared with patients on oral agents (35%) and diet alone (14%) (P < 0.0001). Regression analysis confirmed that providers receiving conventional HbA(1c) results were more likely to intensify therapy in patients who already had HbA(1c) levels ≤7%. Over 2-7 months of follow- up, HbA(1c) rose more in patients with conventional HbA(1c) results compared with rapid results (0.8 vs. 0.4%, P = 0.02). In patients with initial HbA(1c) >7%, rapid HbA(1c) results had a favorable impact on follow-up HbA(1c) independent of the decision to intensify therapy (P = 0.03). CONCLUSIONS - Availability of rapid HbA(1c) determinations appears to facilitate diabetes management. The more favorable follow-up HbA(1c) profile in the rapid HbA(1c) group occurs independently of the decision to intensify therapy, suggesting the involvement of other factors such as enhanced provider and/or patient motivation.

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