Primary Care Research

Physicians are more likely to intensify therapy for diabetes when they get unfavorable blood-sugar test results during visits

Controlling blood-sugar levels (keeping A1c less than 7 percent) can delay or prevent complications of both insulin-dependent (type 1) and noninsulin-dependent (type 2) diabetes. However, many patients continue to have inadequate glycemic control and are at risk for organ damage. Providers often fail to intensify diabetes therapy appropriately when patient glycemic control is poor. Making A1c test results available during medical visits may help to counteract this "clinical inertia," concludes a study supported in part by the Agency for Healthcare Research and Quality (HS09722).

Researchers at Emory University School of Medicine compared intensification of therapy at an urban neighborhood health center for 596 patients with inadequately controlled type 2 diabetes whose doctors received A1c results either during (rapid) or after (routine) patient visits. Rapid A1c results led to more frequent intensification of therapy than routine post-visit A1c results, when the A1c was 7 percent or greater at patients' baseline visits (51 vs. 32 percent), particularly when the A1c was over 8 percent and/or random glucose was in the 151-250 mg/dl range. In 275 patients with two followup visits, A1c fell significantly in the rapid group from 8.4 to 8.1 percent but not in the routine group (8.1 to 8.0 percent).

See "Rapid A1c availability improves clinical decision-making in an urban primary care clinic," by Christopher D. Miller, M.D., Catherine S. Barnes, Ph.D., Lawrence S. Phillips, M.D., and others, in the April 2003 Diabetes Care 26(4), pp. 1158-1163.

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