Levetan Claresa S, Dawn Karen R, Robbins David C, Ratner Robert E
Department of Internal Medicine, Division of Endocrinology, Washington Hospital Center, Washington, DC, USA.
Diabetes Care. 2002 Jan;25(1):2-8. doi: 10.2337/diacare.25.1.2.
The public is increasingly aware of the importance of HbA(1c) testing, yet the vast majority of patients with diabetes do not know their HbA(1c) status or goal. We set forth to evaluate the impact of a system that provides uniquely formatted and personalized reports of diabetes status and goals on changes in HbA(1c) levels.
A total of 150 patients with diabetes were randomized to receive either standard care or intervention inclusive of a computer-generated 11" x 17" color poster depicting an individual's HbA(1c) status and goals along with personalized steps to aid in goal achievement. All patients enrolled received diabetes education during the 3 months before enrollment. HbA(1c) was performed at baseline and 6 months.
At baseline, there were no significant differences between patient groups in terms of age, sex, education level, race, and HbA(1c) or lipid levels. Among patients with baseline HbA(1c) > or =7.0%, there was an 8.6% (0.77% absolute) reduction in HbA(1c) among control subjects compared with a 17.0% (1.69% absolute) decline in the intervention group (P = 0.032). There were no differences between the control and intervention groups with respect to the frequency of patients experiencing any decline in HbA(1c) (63 vs. 69%, P = 0.87); among these patients experiencing a decline, the most substantial reductions were seen with the control group, which had a 13.3% (1.15% absolute) decline compared with the intervention patients, who reduced their HbA(1c) by 24.2% (2.26% absolute reduction; P = 0.0048). At study close, 77% of the patients had their poster displayed on their refrigerator.
This unique and personalized computer-generated intervention resulted in HbA(1c) lowering comparable to that of hypoglycemic agents.
公众越来越意识到糖化血红蛋白（HbA₁c）检测的重要性，但绝大多数糖尿病患者并不知道自己的HbA₁c状态或目标值。我们着手评估一个能提供格式独特且个性化的糖尿病状态及目标报告的系统对HbA₁c水平变化的影响。
总共150例糖尿病患者被随机分为两组，一组接受标准护理，另一组接受干预，干预措施包括一张由计算机生成的11英寸×17英寸彩色海报，上面描绘了个体的HbA₁c状态和目标，以及有助于实现目标的个性化步骤。所有入组患者在入组前3个月均接受了糖尿病教育。在基线和6个月时检测HbA₁c。
在基线时，两组患者在年龄、性别、教育水平、种族、HbA₁c或血脂水平方面无显著差异。在基线HbA₁c≥7.0%的患者中，对照组的HbA₁c降低了8.6%（绝对降低0.77%），而干预组降低了17.0%（绝对降低1.69%）（P = 0.032）。在HbA₁c出现下降的患者频率方面对照组和干预组无差异（63%对69%，P = 0.87）；在这些出现下降的患者中，对照组下降幅度最大，下降了13.3%（绝对降低1.15%），而干预组患者的HbA₁c降低了24.2%（绝对降低2.26%；P = 0.0048）。在研究结束时，77%的患者将海报贴在了冰箱上。
这种独特的、个性化的计算机生成干预措施使HbA₁c降低程度与降糖药物相当。
