HCPLive Network

Patient-Centered Diabetes Care Works Best in Patients with High HbA1c

WEDNESDAY, Sept. 18 (HealthDay News) -- Patient-centered diabetes care is most effective when targeted to patients with HbA1c >8.5 percent, according to a study published online Aug. 15 in Diabetes Care.

Annabelle S. Slingerland, MD, MPH, from the Leiden University Medical Center in the Netherlands, and colleagues randomized 506 patients with type 2 diabetes seen at 13 hospitals (cluster-randomized) to patient-centered (237 patients) or usual care (controls; 269 patients). Change in HbA1c, quality-adjusted life years (QALYs), and costs were the outcomes of interest. Patients were stratified by baseline HbA1c: <7.0 percent (53 mmol/mol), 7.0 to 8.5 percent, and >8.5 percent (69 mmol/mol).

The researchers found that patient-centered care was most effective and cost-effective in those with baseline HbA1c >8.5 percent, with HbA1c reduction after one year of 0.83 percent and an incremental cost-effectiveness ratio (ICER) of US$261 per QALY. This would translate to a lifetime gain of 0.54 QALYs at a cost of US$3,482 (ICER, US$6,443/QALY). For those with baseline HbA1c 7.0 to 8.5 percent, there was a gain of 0.24 QALY at a cost of US$4,731 (ICER, US$20,086/QALY). For patients with a baseline HbA1c <7.0 percent, care was not cost-effective.

"Patient-centered care is more valuable when targeted to patients with HbA1c >8.5 percent (69 mmol/mol), confirming clinical intuition," the authors write.

Abstract
Full Text (subscription or payment may be required)

Copyright © 2013 HealthDay. All rights reserved.

Further Reading
Research indicates that there are probable etiologies of low back pain that can affect treatment outcome and that ignoring pain can possibly cause chronic neurological changes.
Researchers are learning more about the ways in which gut microbiota interact with the central nervous system and the role this can play in pain management.
Although the underlying mechanisms are not fully understood, opioid-induced hyperalgesia occurs in some patients on higher doses of opioids. Treatment options include reducing, rotating, or completely tapering the opioid regimen.
Magnetic resonance is an effective alternative to biopsy for identifying and quantifying fats in the liver, according to results from a study led by a research team at the University of the Basque Country.
Daily supplements of selenium or vitamin E don't seem to protect against the development of age-related cataracts among men, according to a study published online Sept. 18 in JAMA Ophthalmology.
Workplace flu shots are a good investment, a new survey found. The US Centers for Disease Control and Prevention (CDC) on Sept. 19 urged all health care personnel to get flu vaccinations. The CDC also released the results of a survey of 1,882 health care clinicians meant to determine what factors influenced those who got the shots. Among its findings, when workplaces offered free shots on-site, compliance was 61.6% when the vaccinations were offered for one day only. When they were offered for multiple days, compliance rose to 80.4%. When employers did not offer the shots at all, compliance dropped to 49.0%
Cancer patients burdened by stress and family conflicts before surgery may face a higher risk for complications following their operation, according to a study published in a recent issue of the Journal of Gastrointestinal Surgery.
More Reading