Patient-centered diabetes care best in those with high HbA1c

September 18, 2013
Patient-centered diabetes care best in those with high HbA1c
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.

(HealthDay)—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, M.D., M.P.H., from the Leiden University Medical Center in the Netherlands, and colleagues randomized 506 patients with 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.

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