Document Detail


Utility of immediate hemoglobin A1c in children with type I diabetes mellitus.
MedLine Citation:
PMID:  20070556     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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:
Michael S D Agus; Jamin L Alexander; Joseph I Wolfsdorf
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric diabetes     Volume:  11     ISSN:  1399-5448     ISO Abbreviation:  Pediatr Diabetes     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100939345     Medline TA:  Pediatr Diabetes     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  450-4     Citation Subset:  IM    
Copyright Information:
© 2010 John Wiley & Sons A/S.
Affiliation:
Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. michael.agus@childrens.harvard.edu
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