title: A diabetes scorecard does not improve HbA(1c), blood pressure, lipids, aspirin usage, exercise and diabetes knowledge over 9 months: a randomized controlled trial.
abstract: OBJECTIVE
  To test (1) whether a diabetes scorecard can improve glycaemic control, blood pressure control, LDL cholesterol, aspirin usage and exercise; (2) if the scorecard will motivate and/or educate patients to improve their scores for subsequent visits; and (3) whether the scorecard will improve rates of clinical inertia.
  
  
  METHODS
  Five physicians enrolled 103 patients ≥ 40 years old with uncontrolled Type 2 diabetes [HbA(1c) ≥ 64 mmol/mol (8.0%)] to randomly receive either a diabetes scorecard or not during four clinical visits over a 9-month period. The population was predominantly urban with a disproportionately higher percentage of black people than the general population. Our scorecard assigned points to six clinical variables, with a perfect total score of 100 points corresponding to meeting all targets. The primary outcomes were total scores and HbA(1c) in the scorecard and control groups at 9 months.
  
  
  RESULTS
  There were no significant differences between the control and scorecard groups at visits 1 and 4 in total score, HbA(1c) , blood pressure, LDL cholesterol, aspirin usage, exercise or knowledge about diabetic targets. By visit 4 both the control and scorecard groups had statistically significant improvements with their mean total score (9 and 7 points, respectively), HbA(1c) [-9 mmol/mol (-0.8%) and -15 mmol/mol (-1.4%), respectively] and aspirin usage (33% increase and 16% increase, respectively). Rates of clinical inertia were low throughout the study.
  
  
  CONCLUSIONS
  A diabetes scorecard did not improve glycaemic control, blood pressure control, LDL cholesterol, aspirin usage, exercise or diabetic knowledge in an urban population with uncontrolled Type 2 diabetes.
authors.affiliation: Department of Medicine, George Washington University, Washington, DC, USA. mirwig@mfa.gwu.edu
authors.forename: M S
authors.initials: MS
authors.lastname: Irwig
authors.forename: P
authors.initials: P
authors.lastname: Sood
authors.forename: D
authors.initials: D
authors.lastname: Ni
authors.forename: T
authors.initials: T
authors.lastname: Amass
authors.forename: P S
authors.initials: PS
authors.lastname: Khurana
authors.forename: V V
authors.initials: VV
authors.lastname: Jayanthi
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.forename: S M
authors.initials: SM
authors.lastname: Adler
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D044383:Black People; D001794:Blood Pressure / Q000502:physiology*; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000503:physiopathology / Q000523:psychology; D019468:Disease Management; D015444:Exercise / Q000502:physiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000502:physiology; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D016037:Single-Blind Method; D014505:Urban Population; D044465:White People
chemical_list: D001241:Aspirin; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin