Finding the clinical utility of 1,5-anhydroglucitol among primary care practitioners
| Autor: | Jeffrey R. Dahlen, Trever Burgon, David Paculdo, M. Czarina Acelajado, John W. Peabody |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Primary care lcsh:Diseases of the endocrine glands. Clinical endocrinology Simulated patient law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Randomized controlled trial law Diabetes management Diabetes mellitus medicine 030212 general & internal medicine Glycemic variability 1 5 anhydroglucitol Glycemic lcsh:RC648-665 business.industry medicine.disease Clinical utility chemistry Emergency medicine 1 5-Anhydroglucitol Glycated hemoglobin business Research Paper |
| Zdroj: | Journal of Clinical & Translational Endocrinology Journal of Clinical & Translational Endocrinology, Vol 20, Iss, Pp 100224-(2020) |
| ISSN: | 2214-6237 |
| Popis: | Background HbA1c is widely used as the standard measure to track glycemic control in patients with diabetes and pre-diabetes but measures average levels of glycated hemoglobin over two to three months, with limited utility in the presence of recent and/or short-term fluctuations in glycemic control, which are correlated with worse patient outcomes. Methods We examined the clinical utility of 1-5-anhydroglucitol (1,5-AG) in six different, but common, case types of diabetes patients with short-term glycemic variability. We conducted a randomized controlled trial of simulated patients to examine the clinical practice patterns of primary care physicians before and after introducing 1,5-AG. The 145 participants were randomly assigned into standard care or standard care + 1,5-AG arms. Provider care was reviewed against explicit evidence-based care standards. Results At baseline, we saw no difference between the two study arms in clinical quality of care provided (p = 0.997). After introduction of 1,5-AG, standard care + 1,5-AG providers performed 3.2% better than controls (p = 0.025. In diagnosis and treatment, there was a slight, but nonsignificant trend toward better care (+1.1%, p = 0.507) for intervention providers. Upon disaggregation by case, almost all the improvement occurred in the medication-induced hyperglycemia patients (+8.1%, p = 0.047). Conclusions A nationally representative sample of primary care physicians demonstrated that of six different cases used in this study, 1,5-AG was found to be most effective increasing awareness of poor glucose control in medication-induced hyperglycemia. If 1,5-AG is used in this particular circumstance, the overall savings to the healthcare system is estimated to be $28 million. |
| Databáze: | OpenAIRE |
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