Parcero Augusto F, Yaeger Thomas, Bienkowski Robert S
Robert Packer Hospital and Guthrie Clinic, Sayre, PA, USA.
J Prim Care Community Health. 2011 Jul 1;2(3):205-8. doi: 10.1177/2150131911403932. Epub 2011 Apr 19.
The American Diabetes Association recommends measuring hemoglobin A1C levels (A1C) at least semiannually in diabetic patients who have stable glycemic control and quarterly in patients whose therapy has changed or who are not meeting glycemic goals. These guidelines were based on expert consensus without reference to actual clinical data. The main objective of this study was to assess association between meeting a target A1C level of <7% and adherence to monitoring guidelines. Secondary objectives were to determine the proportion of diabetic patients in the authors' practice who met the A1C monitoring guidelines and to assess whether meeting the target A1C level is associated with other information easily abstracted from patients records, namely age, gender, and types of therapy.
This study employed a case control design. Records of 193 type 2 diabetic patients seen over a 6-month period in a rural family medicine clinic were analyzed. Assessment of diabetes control was based on the most recent A1C level, with <7% considered controlled. Adherence to guidelines was assessed by determining frequency of testing during the preceding 12-month period.
Ninety-eight patients (51%) adhered to the American Diabetes Association guidelines on frequency of monitoring A1C. Median levels of adherent and nonadherent patients differed significantly (6.5 vs 7.3, P < .001, Mann-Whitney test). Logistic regression analysis showed that "diabetes control" based on the A1C level is positively associated with adherence to the guidelines, negatively associated with intensity of therapy, and not associated with gender or age.
This study supports the usefulness of American Diabetes Association practice guidelines on the frequency of monitoring A1C levels in diabetic patients.
美国糖尿病协会建议，血糖控制稳定的糖尿病患者至少每半年测量一次糖化血红蛋白水平（A1C），而治疗方案改变或未达血糖目标的患者则应每季度测量一次。这些指南是基于专家共识制定的，未参考实际临床数据。本研究的主要目的是评估达到A1C目标水平<7%与遵循监测指南之间的关联。次要目的是确定作者所在医疗机构中符合A1C监测指南的糖尿病患者比例，并评估达到A1C目标水平是否与可从患者记录中轻松提取的其他信息相关，即年龄、性别和治疗类型。
本研究采用病例对照设计。分析了一家农村家庭医学诊所6个月内诊治的193例2型糖尿病患者的记录。根据最新的A1C水平评估糖尿病控制情况，A1C<7%视为控制良好。通过确定前12个月内的检测频率来评估对指南的遵循情况。
98例患者（51%）遵循了美国糖尿病协会关于A1C监测频率的指南。遵循指南和未遵循指南的患者的中位数水平差异显著（6.5对7.3，P<.001，曼-惠特尼检验）。逻辑回归分析表明，基于A1C水平的“糖尿病控制”与遵循指南呈正相关，与治疗强度呈负相关，与性别或年龄无关。
本研究支持美国糖尿病协会关于糖尿病患者A1C水平监测频率的实践指南的实用性。
