Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial.
Objective: The objective of this study was to assess the impact of active versus usual monitoring of algorithmic insulin titration and point-of-care (POC) versus laboratory HbA1c (A1C) measurement on glycemic control in primary care.Research Design and Methods: The Glycemic Optimization with Algorit...
| Publicado en: | Diabetes Care Vol. 29; no. 1; pp. 1 - 9 |
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| Autores principales: | , , , , , , , |
| Formato: | clinical trial research tables/charts Journal Article |
| Publicado: |
American Diabetes Association
Jan2006
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106354596&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106354596 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01495992 1G7 jtl: Diabetes Care issn: 01495992 maglogo: N pubinfo: dt: Jan2006 vid: 29 iid: 1 pid: 1367 pub: American Diabetes Association place: Arlington, Virginia artinfo: ui: 106354596 106354596 NLM16373887 2009297567 10.2337/diacare.29.01.06.dc05-1058 NLM16373887 106354596 ppf: 1 ppct: 8 formats: tig: atl: Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial. aug: au: Kennedy L Herman WH Strange P Harris A Kennedy, Laurence Herman, William H Strange, Poul Harris, Anthony affil: Division of Endocrinology, Department of Medicine, Shands Hospital at the University of Florida, Gainesville, Florida 32610, USA sug: subj: Algorithms Utilization Blood Glucose Metabolism Diabetes Mellitus, Type 2 Blood Glycated Hemoglobin Analysis Administration, Oral Adult Aged Analysis of Covariance Analysis of Variance Blood Glucose Self-Monitoring Body Mass Index Chi Square Test Clinical Trials Comparative Studies Diabetes Mellitus, Type 2 Drug Therapy Female Funding Source Hypoglycemic Agents Administration and Dosage Hypoglycemic Agents Therapeutic Use Kruskal-Wallis Test Male Middle Age Population Random Assignment Human Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Objective: The objective of this study was to assess the impact of active versus usual monitoring of algorithmic insulin titration and point-of-care (POC) versus laboratory HbA1c (A1C) measurement on glycemic control in primary care.Research Design and Methods: The Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) study was a 24-week, randomized, parallel-group, four-arm, open-label study of 7,893 adults with type 2 diabetes uncontrolled by oral antidiabetic agents and requiring insulin. Patients were randomly assigned by investigators from 2,164 sites in the U.S. to insulin glargine with either 1) usual (no unsolicited contact between visits) insulin titration using a simple algorithm with laboratory A1C testing, 2) usual titration with POC A1C testing, 3) active (weekly monitored) titration with laboratory A1C testing, or 4) active titration with POC A1C testing. Outcome measures included a change in A1C and fasting self-monitoring of blood glucose (SMBG) levels, percentage of patients achieving A1C <7.0%, and hypoglycemia frequency.Results: Significant A1C and SMBG reductions were observed in all arms (P < 0.0001). Compared with usual insulin titration, active titration achieved greater A1C reduction (1.5 vs. 1.3%; P < 0.0001), SMBG reduction (88 vs. 79 mg/dl; P < 0.0001), and proportion of patients achieving A1C <7.0% (38 vs. 30%; P < 0.0001). Among patients receiving active titration, POC A1C testing was associated with an increase in the proportion achieving an A1C <7.0% (41% for POC vs. 36% for laboratory; P < 0.0001). Hypoglycemia rates were low (usual vs. active groups: 3.7 vs. 6.0 all confirmed episodes/patient-year [P < 0.001]; 0.09 vs. 0.14 severe episodes/patient-year [NS]).Conclusions: In a predominantly primary care setting, addition of insulin glargine using a simple algorithm achieved significant improvements in glycemic control in patients with type 2 diabetes in all four study arms. Active titration resulted in significant incremental improvements in glycemic control, and, among patients receiving active titration, POC A1C testing resulted in a greater portion achieving A1C <7.0%. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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