Gopalan Anjali, Tahirovic Emin, Moss Haley, Troxel Andrea B, Zhu Jingsan, Loewenstein George, Volpp Kevin G
The Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA,
J Gen Intern Med. 2014 Jul;29(7):996-1003. doi: 10.1007/s11606-014-2810-4. Epub 2014 Feb 25.
Previous work has indicated that for patients with diabetes, there is value in understanding glycemic control. Despite these findings, patient understanding of the hemoglobin A1C value (A1C) is notably poor. In this study, we test the effect of two alternative communication formats of the A1C on improving glycemic control among patients with poorly controlled diabetes.
177 patients with poorly controlled diabetes were randomized to one of three study arms that varied in the information they received: (1) a "diabetes report card" containing individualized information about glycemic control for each participant with letter grades ranging from A to F; (2) a "report card" containing a face whose emotion reflected current glycemic control; or (3) a "report card" with glycemic control expressed with the A1C value (standard arm). The primary study outcome was change in A1C at 6 months. Secondary outcomes included changes in participant perceptions of their glycemic control.
The average A1C for enrolled participants was 9.9 % (S.D. 1.7) and did not differ significantly among study arms. We noted no significant differences in change in A1C at 6 months between the standard and experimental arms. Using multiple imputation to account for missing A1C values, the changes in A1C for the letter grade, face, and standard arms were -0.55 % (-1.15, 0.05), -0.89 % (-1.49, -0.29), and -0.74 % (-1.51, 0.029), respectively (p = 0.67 for control vs. grade, p = 0.76 for control vs. face).
Feedback to patients with poorly controlled diabetes in the form of letter grades and faces did not differentially impact glycemic control at 6 months or participant perceptions of current control. These efforts to improve communication and patient understanding of disease management targets need further refinement to significantly impact diabetes outcomes.
NCT01143870.
先前的研究表明，对于糖尿病患者而言，了解血糖控制情况具有重要意义。尽管有这些研究结果，但患者对糖化血红蛋白值（A1C）的理解仍非常欠缺。在本研究中，我们测试了两种不同形式的A1C信息传达方式对改善血糖控制不佳的糖尿病患者血糖水平的效果。
177例血糖控制不佳的糖尿病患者被随机分为三个研究组，每组所接收的信息不同：（1）“糖尿病成绩单”，包含每位参与者血糖控制的个性化信息，用A到F的字母等级表示；（2）“成绩单”，上面有一张脸，其表情反映当前的血糖控制情况；（3）“成绩单”，用A1C值表示血糖控制情况（标准组）。主要研究结局是6个月时A1C的变化。次要结局包括参与者对自身血糖控制认知的变化。
入组参与者的平均A1C为9.9%（标准差1.7），各研究组之间无显著差异。我们发现标准组与试验组在6个月时A1C的变化无显著差异。采用多重填补法处理缺失的A1C值后，字母等级组、表情组和标准组的A1C变化分别为-0.55%（-1.15，0.05）、-0.89%（-1.49，-0.29）和-0.74%（-1.51，0.029）（对照组与字母等级组比较，p = 0.67；对照组与表情组比较，p = 0.76）。
以字母等级和表情形式向血糖控制不佳的糖尿病患者提供反馈，在6个月时对血糖控制或参与者对当前控制情况的认知并无差异影响。这些改善沟通及患者对疾病管理目标理解的努力需要进一步完善，以对糖尿病结局产生显著影响。
NCT01143870。
