The purpose of the research was to investigate the impact of point-of-care (POC) A1C testing among patients with type 2 diabetes in a primary care setting.
Methods
This study used a pretest-posttest design with data from patient charts matched for age, sex, race, body mass index, insurance status, and the number of comorbidities. A random sample of charts of patients with type 2 diabetes in the primary care setting was reviewed 6 months and 3 months pre- and post-implementation of the POC A1C testing.
Results
There was a significant difference in the number of A1Cs documented in the medical record pre- versus post-implementation of POC A1C. There was also a significant difference in A1C values pre- versus post-implementation. There was also a difference in the treatment changes pre- versus post-implementation of POC A1C.
Conclusion
Point-of-care A1C testing represents an opportunity for improved care of people with diabetes. The significance of this improvement will become more critical as the number of people with type 2 diabetes continues to increase.
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References
1.
American Diabetes Association (ADA). Standards of medical care in diabetes-2010. Diabetes Care. 2010;33(Suppl 1):S11-S61.
2.
DelamaterAM. Clinical use of hemoglobin A1C to improve diabetes management, Clin Diabetes. 2006;24:6-8.
3.
The Diabetes Control and Complications Trial Research Group (DCCT). The effects of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.
4.
HarwellTSDettoriNMcDowallJM. Do persons with diabetes know their (A1C) number?Diabetes Educ. 2002;28:99-105.
5.
LevinSRCoburnJWAbrairaC. Effect of intensive glycemic control on microalbuminuria in type 2 diabetes: Veterans Affairs co-operative study on glycemic control and complications in type 2 diabetes feasibility trial investigators. Diabetes Care. 2000;23:1478-1485.
6.
ParnesBCNiebauerLHolcombS. Provider deferred decisions on hemoglobin A1C results: A report from the ColoradoResearch Network (CaReNet) and the High Plains research Network (HPRN). J Am Board Fam Med. 2006;19:20-23.
7.
UK Prospective Diabetes Study Group (UKPDS). Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 1998;352:837-853.
8.
CaglieroELevinaEVNathanDM. Immediate feedback of HbA1C levels improves glycemic control in type 1 and insulin treated type 2 diabetic patients. Diabetes Care. 1999;22:1785-1789.
9.
KhuntiKStoneMABurdenAC. Randomized control trial of near-patient testing for glycated hemoglobin in people with type 2 diabetes mellitus. Br J Gen Pract. 2006;56:51-57.
10.
MayberryRDavisTAlema-MensahH. Determinants of glycemic status monitoring in Black and White Medicaid beneficiaries with diabetes mellitus. J Health Care Poor Underserved. 2005;16:31-49.
11.
PetersonJRFinleyJBOkoroduduAOMohammedAAGradyJJBajajM. Effect of point of care on maintenance of glycemic control as measured by A1C. Diabetes Care. 2007;30:713-715.
12.
FerencziAReddyKLorberDC. Effect immediate hemoglobin A1C results in treatment decision in office practice. Endocrinol Pract. 2001;7:85-88.
13.
MillerCDBarnesCSPhillipsLS. Rapid A1C availability improves clinical decision making in an urban primary care clinic, Diabetes Care2003;26:1158-1163.
14.
ThalerLMZiemerDCGallinaD. Diabetes in urban African Americans XVII: Availability of rapid HbA1C measurements enhances clinical decision making. Diabetes Care. 1999;22:1415-1421.
15.
WagnerEHSandhuNNewtonKMMcCullochDKRamseySDGrothausLC. Effects of improved glycemic control on health care costs and utilization. JAMA. 2001;10:182-189.
16.
GlimerTO’ConnorPJ. Cost effectiveness of diabetes mellitus management programs: A health plan perspective. Dis Manage Health Outcomes. 2003;11:439-453.
17.
SchwartzKLMonsurJHammondABartocesMGNealeAV. Comparison of point of care and laboratory Hba1C analysis: A metro-net study. J Am Board Fam Med. 2009;22:461-463.
18.
SicardDATaylorJR. Comparison of point of care HbA1C test versus standardized laboratory test. Ann Pharmacother. 2005;29:1024-1128.
19.
CoonPZulkowskiK. Adherence to American Diabetes Association standards of care by rural health care providers. Diabetes Care. 2002;25:2224-2229.
20.
HoergerTJSegelJEGreggEWSaaddineJB. Is glycemic control improving in U.S. adults?Diabetes Care. 2008;31:81-86.
21.
McGlynnEAAschSMAdamsJ. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-2645.
22.
KirkmanMSWilliamsSRCaffreyHHMarreroDG. Impact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care. 2002;25:1946-1951.
23.
Centers for Disease Control and Prevention (CDC). (2011). National Diabetes Fact Sheet: General information and National estimates on Diabetes in the United States. US Department of Health and Human Services. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed May 26, 2011.
24.
ChinMHCookSDrumML. Improving diabetes care in Midwest Community Health Centers with the Health Disparities Collaborative. Diabetes Care. 2004;27:2-8.
25.
WattsSALawrenceRHKernE. Diabetes nurse case management training program: enhancing care consistent with the chronic care and patient-centered medical home models. Clin Diabetes. 2011;29:25-33.
26.
SiminerioLWagnerEHGabbayRZgiborJ. Implementing the chronic care model: a statewide focus on improving diabetes care for Pennsylvania. Clin Diabetes. 2009;27:153-156.
27.
ColemanKAustinBTBrachCWagnerEH. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009;28:75-85.
28.
HeislerMVijanSAndersonRMUbelPABernsteinSJHolerTP. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?J Gen Intern Med. 2003;18:893-902.
29.
HeislerMPietteJDSpencerMKiefferEVijanS. The relationship between knowledge of recent HbA1C values and diabetes care understanding and self management. Diabetes Care. 2005;28:816-823.
30.
GlasgowREFunnellMMBonomiAEDavisCBeckhamVWagnerEH. Self-management aspects of the improving chronic illness care breakthrough series: Implementation with diabetes and heart failure teams. Ann Behav Med. 2002;24:80-87.
