Impact of Computer-Generated Personalized Goals on HbA1c

Abstract

OBJECTIVE—The public is increasingly aware of the importance of HbA_1c testing, yet the vast majority of patients with diabetes do not know their HbA_1c status or goal. We set forth to evaluate the impact of a system that provides uniquely formatted and personalized reports of diabetes status and goals on changes in HbA_1c levels. RESEARCH DESIGN AND METHODS—A total of 150 patients with diabetes were randomized to receive either standard care or intervention inclusive of a computer-generated 11” × 17” color poster depicting an individual’s HbA_1c status and goals along with personalized steps to aid in goal achievement. All patients enrolled received diabetes education during the 3 months before enrollment. HbA_1c was performed at baseline and 6 months. RESULTS—At baseline, there were no significant differences between patient groups in terms of age, sex, education level, race, and HbA_1c or lipid levels. Among patients with baseline HbA_1c ≥7.0%, there was an 8.6% (0.77% absolute) reduction in HbA_1c among control subjects compared with a 17.0% (1.69% absolute) decline in the intervention group (P = 0.032). There were no differences between the control and intervention groups with respect to the frequency of patients experiencing any decline in HbA_1c (63 vs. 69%, P = 0.87); among these patients experiencing a decline, the most substantial reductions were seen with the control group, which had a 13.3% (1.15% absolute) decline compared with the intervention patients, who reduced their HbA_1c by 24.2% (2.26% absolute reduction; P = 0.0048). At study close, 77% of the patients had their poster displayed on their refrigerator. CONCLUSIONS—This unique and personalized computer-generated intervention resulted in HbA_1c lowering comparable to that of hypoglycemic agents.