Elsevier

Endocrine Practice

Volume 7, Issue 2, March 2001, Pages 85-88
Endocrine Practice

Original Article
Effect of Immediate Hemoglobin A1c Results on Treatment Decisions in Office Practice

https://doi.org/10.4158/EP.7.2.85Get rights and content

ABSTRACT

Objective

To assess the effect of an immediately available hemoglobin A1c (HbA1c) result on glycemic control and physician decisions about pharmacologic therapy in an office practice.

Methods

In a 1-year retrospective review of medical records, HbA1c results were analyzed in 115 patients beyond the age of 65 years, who had type 2 diabetes and were referred for the first time to a private endocrinology practice between April 1, 1997, and March 31, 1998. These patients were classified into two groups: group A (N = 93, insured by standard Medicare) had immediate HbA1c results (during the patient encounter) and group B (N = 22, insured by Medicare health maintenance organization [HMO]) had commercial laboratory HbA1c results available within 2 to 3 days. We reviewed the changes in the HbA1c level during the 12-month period and the presence or absence of a change in therapy at each visit. HbA1c levels were measured by ion-exchange low-pressure liquid chromatography in group A and by one of three capitated commercial laboratories (depending on HMO contracts) in group B.

Results

At the end of the 12 months, the mean HbA1c decrease was 1.03 ± 0.33% in group A and 0.33 ± 0.83% in group B. During the first visit, 52% of the patients in group A had pharmacologic treatment interventions, whereas only 27% in group B had such interventions.

Conclusion

Rapid availability of the HbA1c results during the clinical encounter improves the ability of the physician to make appropriate therapeutic decisions and results in improved glycemic control. (Endocr Pract. 2001;7:85-88)

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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