Diabetes compliance not as simple as A1c

admin · Apr 11, 2005

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Diabetes compliance not as simple as A1c
Information is important, but studies suggest it's not enough to prompt patients to change their behavior.

Vipin Jain, MD, a family physician in Anderson, Ind., hangs 5-foot by 5-foot color-coded posters in all of his exam rooms to help patients with diabetes improve their understanding about hemoglobin A1c values.

The message is something like this: If the number is less than 7%, the patient is classified as "green" or good to go. A number that's a little higher moves them into the yellow zone, and signals them to think about what they need to do. Significantly higher values categorize them as "red," which means that action must be taken.

"It's extremely important for patients and physicians to know the A1c," said Dr. Jain, who also is the medical director of the Madison County Health Center. "I use all the tools that I have access to."

This type of color system is one of the many strategies that physicians around the country are using to communicate HbA1c values, increasingly the cornerstone of diabetes management. But questions persist about how knowing this value impacts behavioral changes and health outcomes for patients with diabetes.

Anecdotal evidence and a growing body of scientific literature indicate that a worrisome disconnect exists. A study in the April Diabetes Care found most patients had no idea what their HbA1c number was. Those who thought they knew it tended to be wrong. Also, although awareness of this value did translate into patients better understanding their conditions, it did not lead to an improvement in self-management behavior.

"Very few people actually know their numbers, and those who do, they're not at all accurate," said Sandeep Vijan, MD, one of the study's authors and an internist with the Veterans Affairs Center for Practice Management and Outcomes Research in Ann Arbor, Mich.
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