Research Aim: To demonstrate that physicians are more likely to intensify management of uncontrolled type 2 diabetes and to achieve higher rates of glycemic control when hemoglobin A1C levels are immediately available using an in-office hemoglobin analyzer. Primary Hypotheses: Immediate feedback from an in office hemoglobin A1C analyzer will a) significantly increase the rate in which physicians decide to intensify diabetes therapy when indicated in patients with uncontrolled type 2 diabetes; and, b) significantly improve the level of glycemic control achieved in such patients. Research design: Group-controlled trial. Population & Sampling Frame: The study will include low-income, minority, and uninsured patients served by primary care clinicians at a federally-funded community health center in Atlanta, Georgia. Adult patients with type 2 diabetes will be included. Intervention Methods: We will test the effect of implementing a standing order for nurses to perform an immediate HgbA1 C test before the patient is seen by the doctor (just as most centers now perform a finger-tick random blood glucose test as part of measuring routine vital signs for a diabetic patient), and by providing the equipment (Bayer DCA-2000) and supplies needed to implement this standing order. Intensification of therapy will be determined by documented evidence in the medical record of a change in the medical regimen (drug, dosage, or schedule) or nutritionist referral. Outcome Measures: (1) Change in rate of intensification of therapy (before and after intervention) at intervention site compared to before- after change at 3 satellite clinics used as control sites; (2) Before-after change in mean value of Hgb A1C at intervention site compared to control sites.
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