Utility of immediate hemoglobin A1c in children with type I diabetes mellitus

Objective: Immediate feedback (IFB) of hemoglobin A1c (HbA1c) results to adults with type 1 and 2 diabetes allows more appropriate care decisions at the clinic visit and may improve glycemic control. Our objective is to determine whether IFB of HbA1c results to children with type 1 diabetes will improve patient care and glycemic control. Methods: In this prospective randomized controlled trial, children under 18 years of age were randomly assigned to receive HbA1c results during their diabetes clinic visit by point-of-care fingerstick testing (immediate) or several days after by venipuncture and laboratory assessment (conventional). HbA1c levels, therapy changes, and painfulness of testing were recorded at baseline and every follow-up appointment for a year. Results: The 215 patients studied had similar baseline characteristics including initial HbA1c (7.90 +/- 1.24% vs. 7.81 +/- 1.13%, p = 0.25). IFB improved HbA1c at 3 months (-0.20 +/- 0.66%, p = 0.005) with a return to baseline for the remainder of the study. Subjects receiving conventional feedback had increased HbA1c results at 12 months (+0.27 +/- 1.05%, p = 0.048). Less frequent patient-clinician communication between visits was reported with IFB (0.29 +/- 0.48 vs. 0.38 +/- 0.49 contacts/visit, p = 0.043). Subjects rated fingersticks as less painful than conventional venipuncture (0.30 +/- 0.66 vs. 3.9 +/- 2.6, p < 0.001). Conclusions: IFB of HbA1c is a more acceptable method of HbA1c determination in children with type 1 diabetes mellitus. Although sustained improvements in glycemic control did not result from this intervention alone, IFB testing resulted in more efficient patient-clinician communication and was less painful.