Lenters-Westra E, Schindhelm R K, Bilo H J G, Groenier K H, Slingerland R J
Department of Clinical Chemistry, Isala, Zwolle, the Netherlands.
Neth J Med. 2014 Nov;72(9):462-6.
To assess the expected precision of HbA1c measurements and the magnitude of HbA1c changes eliciting the advice to change treatment among diabetes care professionals.
A seven-item questionnaire was sent to participants through a website. The survey focused on physicians and nurses involved in diabetes care.
In total, 104 physicians, 177 diabetes specialist nurses, and 248 primary care nurses responded to the survey. A large number of the nurses (44%) and only a small number of the physicians (4%) were not aware of the inherent uncertainty of HbA1c results. Nurses considered adjusting therapy based on very small changes in HbA1c whereas physicians in general adhere to 0.5% (5.5 mmol÷mol) as a clinically meaningful cut-off point. After therapy adjustment, a very small (0.1%) or no increase in HbA1c was considered to be significant enough to conclude that glucose regulation has worsened by 49% of the nurses and only 13% of the physicians.
Significant differences exist in the interpretation of changes in HbA1c results between physicians and nurses. Nurses consider therapy changes based on very small changes in HbA1c, whereas physicians preferably agree to the clinically relevant change of 0.5% (5.5 mmol÷mol). Changing therapy based on relatively small changes in HbA1c might lead to undue adjustments in the treatment of patients with diabetes. There is a clear need for more training for all diabetes care professionals about both the clinical significance and accuracy of HbA1c measurements.
评估糖化血红蛋白（HbA1c）测量的预期精度以及促使糖尿病护理专业人员建议改变治疗方案的HbA1c变化幅度。
通过网站向参与者发送一份包含七个条目的问卷。该调查聚焦于参与糖尿病护理的医生和护士。
共有104名医生、177名糖尿病专科护士和248名初级护理护士回复了调查。大量护士（44%）并不知晓HbA1c结果存在固有不确定性，而只有少数医生（4%）不了解。护士们认为基于HbA1c的极小变化就调整治疗方案，而医生总体上坚持将0.5%（5.5 mmol/mol）作为具有临床意义的临界点。在调整治疗后，HbA1c仅有极小幅度（0.1%）升高或未升高，49%的护士认为这足以判定血糖调节恶化，而只有13%的医生这样认为。
医生和护士对HbA1c结果变化的解读存在显著差异。护士会基于HbA1c的极小变化考虑改变治疗方案，而医生更倾向于认可具有临床相关性的0.5%（5.5 mmol/mol）的变化。基于HbA1c相对较小的变化改变治疗方案可能会导致对糖尿病患者治疗的不当调整。显然，所有糖尿病护理专业人员都需要接受更多关于HbA1c测量的临床意义和准确性的培训。
