Original ArticleEffect of Immediate Hemoglobin A1c Results on Treatment Decisions in Office Practice
Section snippets
INTRODUCTION
Routine determination of glycosylated hemoglobin (HbA1c) is now the standard of care for evaluating the control of diabetes. This measurement provides valuable information, necessary for determining the effectiveness of the therapeutic plan and for facilitating timely change in the therapeutic regimen. Initially a cumbersome assay limited to larger laboratories, an accurate HbA1c test can now be performed within 6 to 10 minutes, and results can be provided at the time of the patient interaction
Study Subjects and Methods
This study was conducted at a private endocrinology office. At the first visit, all patients were assessed by an endocrinologist, who outlined a treatment plan.
RESULTS
The Medicare group of patients (group A) had therapeutic interventions at 40% of all clinical visits (145 of 362); in contrast, the HMO group of patients (group B) had therapeutic interventions at 24% of visits (19 of 80) (P = 0.006) (Table 1). The initial mean HbA1c value was 9.5 ± 1.9% in group A and 8.3 ± 1.7% in group B. Therapeutic changes were made in 48 of 93 Medicare patients and 6 of 22 HMO patients at the first visit (P = 0.04) (Table 2).
The levels of HbA1c at the last visit (at 12
DISCUSSION
Physicians, insurers, researchers, and regulators all rely on the HbA1c levels to provide an integrated measure of glycemic control in patients with diabetes mellitus (5,6). The National Committee for Quality Assurance, following the Health Plan Employer Data and Information Set 2000 (7), includes the HbA1c determination as a required measurement for patients with diabetes mellitus and requires reporting of the number of such patients with above normal levels. The availability of HbA1c results
CONCLUSION
Our study indicates that improved glycemic control was achieved by the ready availability of HbA1c results to the physician and the patient at the time of the consultation. Having HbA1c results available at the time of the patient visit in a private endocrinology practice improves clinical decision making and blood glucose outcomes. Thus, we recommend that managed care organizations allow reimbursement for point-of-service HbA1c determinations.
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2020, American Journal of Preventive MedicineCitation Excerpt :Formative work showed an association between POC HbA1c testing and metformin prescription for patients with prediabetes.14 POC HbA1c has been shown to aid T2DM management, resulting in more frequent treatment adjustments and better HbA1c control,28,29 but its utility in prediabetes care has not been previously reported. The 2 possible explanations for this association are as follows: (1) clinicians using POC testing have different clinical practices or resources that make them more likely to refer patients to the DPP and (2) POC testing facilitates a face-to-face conversation and development of a treatment plan with the patient, resulting in increased DPP utilization.
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2015, Clinical BiochemistryCitation Excerpt :These efforts, spearheaded by programs such as the National Glycohemoglobin Standardization Program (NGSP) HbA1c harmonization program and the IFCC Working Group on HbA1c standardization, have further supported the role of HbA1c in the management of diabetes. In addition, studies have shown that immediate feedback of HbA1c levels is highly effective for controlling plasma glucose levels [3–5]. Thus, point-of-care (POC) instruments, characterized as fast, portable, and easy-to-use, have been shown to be suitable for providing rapid feedback of HbA1c levels.
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