title: Rapid A1c availability improves clinical decision-making in an urban primary care clinic.
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.
  
  
  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.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia 30303, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Miller
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Barnes
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.forename: David C
authors.initials: DC
authors.lastname: Ziemer
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Gallina
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Maryman
authors.forename: Imad M
authors.initials: IM
authors.lastname: El-Kebbi
mesh_terms: D017668:Age of Onset; D000554:Ambulatory Care Facilities; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013997:Time Factors; D014505:Urban Population
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin