The impact of point of care HbA 1c on interventions and outcomes in type 2 diabetes
Johnson, Amy Marie.
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Diabetes mellitus, type 2 is a growing epidemic in the United States and the world. The purpose of this study was to compare (a) interventions performed by the health care provider; (b) provider compliance with standards of care and recommended guidelines; and, (c) differences in the subsequent HbA 1c in persons with type 2 diabetes who receive POC HbA 1c testing with those who do not receive POC testing. Reports were obtained from the electronic medical records system showing those who had POC HbA 1c's and another showing non-POC HbA 1c. Data collected included (1) the intervention trigger, of an HbA 1c greater than 8.0%. LDL greater than or equal to 100 mg/dL, BMI greater than or equal to 27 and/or BP greater than or equal to 130/80, (2) interventions initiated, and (3) the method of intervention. The results showed that there was a statistically significant higher rate of compliance to standards of care of those in Clinic X in comparison to those in Clinic Y. (x2(1,N=45)=5.148, p=0.03.). There was no statistical significance between the POC group (M=0.86;SD=2.16) and the non-POC group (M=-0.9;SD=1.02);t(1.92)p=0.61 however, there was a clinically significant drop in HbA 1c in Clinic X of nearly one percentage point. In conclusion, POC HbA 1c testing increases provider compliance in addressing diabetes and its complications. Providers addressed elevation in HbA 1c, LDL, BP and BMI at a higher rate in those who received POC testing than in those who did not. Additionally, the rate of improvement in the HbA 1c in those who received the POC testing was clinically significant, showing a decrease in potential microvascular complications of 25% as well as a potential decrease in macrovascular disease. Those who did not receive POC testing showed no decrease in risk at all. POC testing has been identified as an important tool in improving diabetes outcomes and is found through this study to be superior compared to outside testing.