Utility of immediate hemoglobin A1c in children with type I diabetes mellitus
Article first published online: 7 JAN 2010
© 2010 John Wiley & Sons A/S
Volume 11, Issue 7, pages 450–454, November 2010
How to Cite
Agus, M. S., Alexander, J. L. and Wolfsdorf, J. I. (2010), Utility of immediate hemoglobin A1c in children with type I diabetes mellitus. Pediatric Diabetes, 11: 450–454. doi: 10.1111/j.1399-5448.2009.00635.x
- Issue published online: 7 JAN 2010
- Article first published online: 7 JAN 2010
- Submitted 5 August 2009. Accepted for publication 11 December 2009
- diabetes type 1;
- point-of-care testing
Agus MSD, Alexander JL, Wolfsdorf JI. Utility of immediate hemoglobin A1c in children with type I diabetes mellitus.
Objective: Immediate feedback (IFB) of hemoglobin A1c (HbA1c) results to adults with type 1 and 2 diabetes allows more appropriate care decisions at the clinic visit and may improve glycemic control. Our objective is to determine whether IFB of HbA1c results to children with type 1 diabetes will improve patient care and glycemic control.
Methods: In this prospective randomized controlled trial, children under 18 years of age were randomly assigned to receive HbA1c results during their diabetes clinic visit by point-of-care fingerstick testing (immediate) or several days after by venipuncture and laboratory assessment (conventional). HbA1c levels, therapy changes, and painfulness of testing were recorded at baseline and every follow-up appointment for a year.
Results: The 215 patients studied had similar baseline characteristics including initial HbA1c (7.90 ± 1.24% vs. 7.81 ± 1.13%, p = 0.25). IFB improved HbA1c at 3 months (−0.20 ± 0.66%, p = 0.005) with a return to baseline for the remainder of the study. Subjects receiving conventional feedback had increased HbA1c results at 12 months (+0.27 ± 1.05%, p = 0.048). Less frequent patient–clinician communication between visits was reported with IFB (0.29 ± 0.48 vs. 0.38 ± 0.49 contacts/visit, p = 0.043). Subjects rated fingersticks as less painful than conventional venipuncture (0.30 ± 0.66 vs. 3.9 ± 2.6, p < 0.001).
Conclusions: IFB of HbA1c is a more acceptable method of HbA1c determination in children with type 1 diabetes mellitus. Although sustained improvements in glycemic control did not result from this intervention alone, IFB testing resulted in more efficient patient–clinician communication and was less painful.