title: Translating the hemoglobin A1C with more easily understood feedback: a randomized controlled trial.
abstract: BACKGROUND
  Previous work has indicated that for patients with diabetes, there is value in understanding glycemic control. Despite these findings, patient understanding of the hemoglobin A1C value (A1C) is notably poor. In this study, we test the effect of two alternative communication formats of the A1C on improving glycemic control among patients with poorly controlled diabetes.
  
  
  METHODS
  177 patients with poorly controlled diabetes were randomized to one of three study arms that varied in the information they received: (1) a "diabetes report card" containing individualized information about glycemic control for each participant with letter grades ranging from A to F; (2) a "report card" containing a face whose emotion reflected current glycemic control; or (3) a "report card" with glycemic control expressed with the A1C value (standard arm). The primary study outcome was change in A1C at 6 months. Secondary outcomes included changes in participant perceptions of their glycemic control.
  
  
  RESULTS
  The average A1C for enrolled participants was 9.9 % (S.D. 1.7) and did not differ significantly among study arms. We noted no significant differences in change in A1C at 6 months between the standard and experimental arms. Using multiple imputation to account for missing A1C values, the changes in A1C for the letter grade, face, and standard arms were -0.55 % (-1.15, 0.05), -0.89 % (-1.49, -0.29), and -0.74 % (-1.51, 0.029), respectively (p = 0.67 for control vs. grade, p = 0.76 for control vs. face).
  
  
  CONCLUSIONS
  Feedback to patients with poorly controlled diabetes in the form of letter grades and faces did not differentially impact glycemic control at 6 months or participant perceptions of current control. These efforts to improve communication and patient understanding of disease management targets need further refinement to significantly impact diabetes outcomes.
  
  
  BACKGROUND
  NCT01143870.
authors.affiliation: The Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA, agopalan@upenn.edu.
authors.forename: Anjali
authors.initials: A
authors.lastname: Gopalan
authors.forename: Emin
authors.initials: E
authors.lastname: Tahirovic
authors.forename: Haley
authors.initials: H
authors.lastname: Moss
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.forename: George
authors.initials: G
authors.lastname: Loewenstein
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005246:Feedback; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D057220:Health Literacy / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011379:Prognosis; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents