title: Utility of immediate hemoglobin A1c in children with type I diabetes mellitus.
abstract: OBJECTIVE
  Immediate feedback (IFB) of hemoglobin A1c (HbA1c) results to adults with type 1 and 2 diabetes allows more appropriate care decisions at the clinic visit and may improve glycemic control. Our objective is to determine whether IFB of HbA1c results to children with type 1 diabetes will improve patient care and glycemic control.
  
  
  METHODS
  In this prospective randomized controlled trial, children under 18 years of age were randomly assigned to receive HbA1c results during their diabetes clinic visit by point-of-care fingerstick testing (immediate) or several days after by venipuncture and laboratory assessment (conventional). HbA1c levels, therapy changes, and painfulness of testing were recorded at baseline and every follow-up appointment for a year.
  
  
  RESULTS
  The 215 patients studied had similar baseline characteristics including initial HbA1c (7.90 ± 1.24% vs. 7.81 ± 1.13%, p = 0.25). IFB improved HbA1c at 3 months (-0.20 ± 0.66%, p = 0.005) with a return to baseline for the remainder of the study. Subjects receiving conventional feedback had increased HbA1c results at 12 months (+0.27 ± 1.05%, p = 0.048). Less frequent patient-clinician communication between visits was reported with IFB (0.29 ± 0.48 vs. 0.38 ± 0.49 contacts/visit, p = 0.043). Subjects rated fingersticks as less painful than conventional venipuncture (0.30 ± 0.66 vs. 3.9 ± 2.6, p < 0.001).
  
  
  CONCLUSIONS
  IFB of HbA1c is a more acceptable method of HbA1c determination in children with type 1 diabetes mellitus. Although sustained improvements in glycemic control did not result from this intervention alone, IFB testing resulted in more efficient patient-clinician communication and was less painful.
authors.affiliation: Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. michael.agus@childrens.harvard.edu
authors.forename: Michael S D
authors.initials: MS
authors.lastname: Agus
authors.forename: Jamin L
authors.initials: JL
authors.lastname: Alexander
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Wolfsdorf
mesh_terms: D000328:Adult; D001800:Blood Specimen Collection / Q000379:methods; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2; D005246:Feedback; D005385:Fingers / Q000098:blood supply; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D010146:Pain; D018962:Phlebotomy; D019095:Point-of-Care Systems
chemical_list: D006442:Glycated Hemoglobin