SAN DIEGO — Nearly half of adult patients who received care at a municipal hospital diabetes clinic did not recognize the term A1c, and fewer than one-quarter knew what their hemoglobin A1c level should be, Mary K. Rhee, M.D., reported at the annual scientific sessions of the American Diabetes Association.
“This lack of recognition and knowledge occurs despite a formal diabetes education and reinforcement at each patient visit,” said Dr. Rhee of the department of medicine at Emory University, Atlanta.
“However, patients who recognize the term A1c and know the goal have better glycemic control. In light of these findings, education programs should include strategies that ensure that patients achieve and retain appropriate understanding of A1c and the A1c goal,” she said.
To test a theory that patients who know the American Diabetes Association goal for hemoglobin A1c level have better glycemic control, Dr. Rhee and her associates surveyed 97 patients who received care at a diabetes clinic affiliated with Emory University. All patients new to the clinic attend an 8-hour education program which includes instruction about the importance of glycemic control, what A1c is, and what the A1c goal is.
“The program begins at the initial visit and continues over several visits in the first 6 months,” Dr. Rhee explained. “The nurse providers are also expected to routinely discuss individual A1c results and reemphasize the A1c goal with each patient.”
The average age of study participants was 59 years, and 54% were female. Almost all the patients (95%) were African American, and their average body mass index was 35 kg/m
The average duration of diabetes was 10 years, and time since the initial education was 6.5 years. Participants had an average of 3.7 visits to the clinic per year, and the mean A1c level of study participants at the time of the survey was 7.8%.
Based on their response to the question, “What should your A1c be?” patients were divided into three groups. Group 1 consisted of those who did not know either the A1c term or the A1c goal (47%), group 2 recognized the A1c term but did not know the goal (30%), and group 3 knew both the A1c term and the correct A1c goal (23%).
Even though patient characteristics were similar in the three groups, those in group 3 had lower A1c levels (6.9%), compared with their counterparts in group 2 (7.7%) and group 1 (8.4%).
Moreover, knowing the A1c term and goal was independently associated with lower A1c levels after the investigators adjusted for other risk factors. Poor patient knowledge was independently associated with higher A1c levels.
Fewer than 45% of patients in groups 1 and 2 were able to reach an A1c level of less than 7%, while 64% of those in group 3 reached that goal.
“Therefore, better patient knowledge was associated with better glycemic control,” Dr. Rhee concluded.