Impact of computer-generated personalized goals on HbA(1c).
OBJECTIVE
The public is increasingly aware of the importance of HbA(1c) testing, yet the vast majority of patients with diabetes do not know their HbA(1c) status or goal. We set forth to evaluate the impact of a system that provides uniquely formatted and personalized reports of diabetes status and goals on changes in HbA(1c) levels.


METHODS
A total of 150 patients with diabetes were randomized to receive either standard care or intervention inclusive of a computer-generated 11" x 17" color poster depicting an individual's HbA(1c) status and goals along with personalized steps to aid in goal achievement. All patients enrolled received diabetes education during the 3 months before enrollment. HbA(1c) was performed at baseline and 6 months.


RESULTS
At baseline, there were no significant differences between patient groups in terms of age, sex, education level, race, and HbA(1c) or lipid levels. Among patients with baseline HbA(1c) > or =7.0%, there was an 8.6% (0.77% absolute) reduction in HbA(1c) among control subjects compared with a 17.0% (1.69% absolute) decline in the intervention group (P = 0.032). There were no differences between the control and intervention groups with respect to the frequency of patients experiencing any decline in HbA(1c) (63 vs. 69%, P = 0.87); among these patients experiencing a decline, the most substantial reductions were seen with the control group, which had a 13.3% (1.15% absolute) decline compared with the intervention patients, who reduced their HbA(1c) by 24.2% (2.26% absolute reduction; P = 0.0048). At study close, 77% of the patients had their poster displayed on their refrigerator.


CONCLUSIONS
This unique and personalized computer-generated intervention resulted in HbA(1c) lowering comparable to that of hypoglycemic agents.
Levetan
Claresa S
CS
Department of Internal Medicine, Division of Endocrinology, Washington Hospital Center, Washington, DC, USA. levetan@juno.com
Dawn
Karen R
KR
Robbins
David C
DC
Ratner
Robert E
RE
D015415:Biomarkers / Q000097:blood*; D003194:Computer-Assisted Instruction / Q000379:methods*; D003920:Diabetes Mellitus / Q000097:blood* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*
D015415:Biomarkers; D006442:Glycated Hemoglobin