July 8, 2013

Why Do Studies Use Patients with High A1c's

The last two studies that I have become interested in have used patients with A1c's above 8.0% or above 183 mg/dl (10.2 mmol/L). To me, this is scary and frightening. Maybe I should not even write about this. These people are 1) not receiving education, 2) have received bad education, 3) not receiving support from their doctor, or 4) don't care to manage their diabetes.

Even this last study amazes me in that fact that the peer coaches had A1c's of less than 8.5%. This may have been the surprises, as they may not have expected the drop they received from the peer coached group. The number of peer coaches numbered 24.

Before the study it was stated the coaches had to be recommended by their primary care physicians and received 36 hours of training over 8 weeks. This was based on a curriculum that included instruction in active listening and nonjudgmental communication. Also covered was helping with diabetes self-management skills, providing emotional and social support, assisting with lifestyle change and medication understanding/adherence, and accessing community resources.

Again, the study number was small with almost 300 participants selected. They were randomly assigned to receive either coaching or usual care. Why the patients were assessed using questionnaires is not understood. They also received a clinical evaluation at the start to establish a baseline and again at six months.

At baseline, the patients in the peer coaching group had a mean HbA1c of 10.1% for the 148 patients. At six months, the peer coached group had a mean HbA1c of 9.0% or a drop of 1.1%. Also the peer coached group had 22% with HbA1c's below 7.5%.

Now compare this to the usual care group. The usual care group numbered 151 patients and had a mean HbA1c of 9.8%. At six months, the mean HbA1c was at 9.5% for only a decrease of 0.3%. Only 8% in the usual care group had HbA1c levels below 7.5%.

This is significant even with a small number of participants. And yet, the American Association of Diabetes Educators continues to discourage lay people and won't open a class for them and provide any training. Think what could be the potential benefit for millions of diabetes patients not being served currently by the AADE.

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