Chronic Disease

A standing order to perform finger-stick HbA1c tests on patients with diabetes reduces patient blood sugar levels

Reducing blood sugar levels among people with diabetes reduces their risk of diabetes-related complications such as blindness, lower extremity amputation, and end-stage renal and cardiovascular disease. A standing order to use finger-stick glycosylated hemoglobin (HbA1c) testing on primary care patients with diabetes, which provides instant results to the doctor, can reduce patient blood sugar levels, according to a new pilot study at one urban community health center.

Prior to this standing order protocol, the HbA1c test was not performed until the clinician ordered it. Once the test was ordered, the patient had to go to the lab to have blood drawn and sent out to a reference lab. If results were abnormal, the patient would have to be contacted and return for followup to intensify the treatment regimen (increased medication dosage, additional medication, change in medication, referral to a nutritionist and/or health educator, and/or a written exercise prescription).

The researchers reviewed the charts of center patients with diabetes to compare preintervention and postintervention HbA1c tests performed, patient HbA1c levels, and whether clinicians had intensified the diabetic regimen when HbA1c levels were greater than 8 percent (when the risk of diabetes-related complications is high). Of the 106 adult patients studied (average age of 60 years), most were black women. HbA1c testing rates increased from 73.6 to 86.8 percent during the study period. For the 69 patients who had both pre- and post-intervention results, HbA1c levels declined significantly from 8.55 to 7.84. Also, the proportion of patients with HbA1c levels greater than 8 percent decreased slightly from 44.9 percent to 42.4 percent.

The health center was delivering intensified diabetic regimens to less than 3 out of 10 patients who had elevated HbA1c levels prior to the intervention. This improved to more than half of patients (53.8 percent) with the intervention. The study was supported in part by the Agency for Healthcare Research and Quality (HS10875 and HS11617).

See "Point of care testing to improve glycemic control," by George Rust, M.D., M.P.H., Morna Gailor, M.P.H., Elvan Daniels, M.D., and others, in the International Journal of Health Care Quality Assurance 21(3), pp. 325-335, 2008.

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