OBJECTIVE - Failure to meet goals for glycemic control in primary care settings may be due in part to lack of information critical to guide intensification of therapy. Our objective is to determine whether rapid-turnaround Alc availability would improve intensification of diabetes therapy and reduce Alc levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - In this prospective controlled trial, Alc was determined on capillary glucose samples and made available to providers, either during ("rapid") or after ("routine") the patient visit. Frequency of intensification of pharmacological diabetes therapy in inadequately controlled patients and Alc levels were assessed at baseline and after follow-up. RESULTS - We recruited 597 subjects. Patients were 79% female and 96% African American, with average age of 61 years, duration of diabetes 10 years, BMI 33 kg/m2, and Alc 8.5%. The rapid and routine groups had similar clinical demographics. Rapid Alc availability resulted in more frequent intensification of therapy when Alc was ≥ 7.0% at the baseline visit (51 vs. 32% of patients, P = 0.01), particularly when Alc was >8.0% and/or random glucose was in the 8.4-14.4 mmol/l range (151-250 mg/dl). In 275 patients with two follow-up visits, Alc fell significantly in the rapid group (from 8.4 to 8.1%, P = 0.04) but not in the routine group (from 8.1 to 8.0%, P = 0.31). CONCLUSIONS - Availability of rapid Alc measurements increased the frequency of intensification of therapy and lowered Alc levels in patients with type 2 diabetes in an urban neighborhood health center.
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Advanced and Specialized Nursing