Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic

Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic Christopher D. Miller , MD , Catherine S. Barnes , PHD , Lawrence S. Phillips , MD , David C. Ziemer , MD , Daniel L. Gallina , MD , Curtiss B. Cook , MD , Sandra D. Maryman , MD and Imad M. El-Kebbi , MD From the Emory University School of Medicine, Atlanta, Georgia Abstract 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 A1c availability would improve intensification of diabetes therapy and reduce A1c levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS —In this prospective controlled trial, A1c 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 A1c 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/m 2 , and A1c 8.5%. The rapid and routine groups had similar clinical demographics. Rapid A1c availability resulted in more frequent intensification of therapy when A1c was ≥7.0% at the baseline visit (51 vs. 32% of patients, P = 0.01), particularly when A1c 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, A1c 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 A1c measurements increased the frequency of intensification of therapy and lowered A1c levels in patients with type 2 diabetes in an urban neighborhood health center. Footnotes Address correspondence and reprint requests to Imad M. El-Kebbi, MD, Emory University School of Medicine, Diabetes Unit, 69 Jesse Hill Jr. Dr., SE, Atlanta, GA 30303. E-mail: ielkebb{at}emory.edu . Received for publication 13 August 2002 and accepted in revised form 10 January 2003. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE