Clinical Decisions Regarding HbA1c Results in Primary Care

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Abstract
OBJECTIVE—To describe decisions made by primary care providers on elevated HbA1c results and their reasons for not intensifying therapy. RESEARCH DESIGN AND METHODS—In this cross-sectional study, a provider survey was administered in two practice-based research networks when HbA1c results were reviewed on all nonpregnant patients >18 years old with type 2 diabetes. Univariate and Mantel-Hantel analyses assessed associations between patient characteristics and clinical decisions. RESULTS—A total of 483 surveys were completed by at least 88 providers at 19 clinics. Most patients were female (62.5%), mean age was 60 years, and 28.6% were Hispanic. The overall action rate on HbA1c results ≥7% (n = 294) was 70.7%. Patients who were black or had Medicare without medication insurance had lower rates of action on HbA1c ≥7 and ≥8%, respectively (P < 0.05). The most common reasons providers reported for inaction were “patient improving/doing well,” “competing demands,” and “hypoglycemic risk.” CONCLUSIONS—Primary care providers generally adhere to national glycemic control guidelines, although there may be disparities in black patients and patients without medication insurance coverage. A variety of reasons were given when control was not intensified.