Research, conducted across 42 ophthalmology centres in the United States, has reported that point-of-care measurement of hemoglobin A1c (HbA1c), combined with personalized diabetes risk assessment and education delivered during retinal ophthalmic visits, compared to routine care, does not appear to improve glycemic control, as assessed by HbA1c level. Despite the fact that a nationwide poll by the American Foundation for the Blind indicated that fear of blindness ranked higher than a fear of AIDS, cancer, stroke, or heart attacks, clinical management and education measures to reduce the risk of blindness did not appear to be securing the desired effect.
The research, conducted as a randomized, multicenter clinical trial, randomly assigned centres to deliver either a study-prescribed augmented diabetes assessment and education program, or the usual routine care for adults with type 1 or 2 diabetes. The specific intervention used included point-of-care measurements of HbA1c, blood pressure, and retinopathy severity and an individualized estimate of the risk of retinopathy progression, including structured education with immediate assessment and feedback regarding participant’s understanding. The researchers measured the mean change in HbA1c level from baseline to 1-year follow-up and found that the more intensive management and education protocol did not alter the short or long-term glycaemic control of diabetic patients when compared with patients who received usual care.
In patients with more-frequent-than-annual follow-ups, the mean (SD) change in HbA1c level at 1 year was −0.1% (1.5%) in the control group and −0.3% (1.4%) in the intervention group (adjusted mean difference, −0.09% [95% CI, −0.29% to 0.12%]; P = .35). In the cohort with annual follow-ups, the mean (SD) change in HbA1c level was 0.0% (1.1%) in the control group and −0.1% (1.6%) in the intervention group (mean difference, −0.05% [95% CI, −0.27% to 0.18%]; P = .63). The researchers found that only 36% to 40% of participants were willing to provide an email address to receive intervention materials and, of the 277 participants who did provide an email contact, 72% never actually accessed the dedicated website. Given the epidemic of diabetes worldwide the research suggests that more intense efforts and delivery mechanisms are required in order to more efficiently emphasize the clear beneficial impact of improved glycemic control. The researchers comment that, “our results emphasize the difficulty of changing personal behavior and treatment paradigms through education, even when the participant is motivated by fear of possible future ocular and renal complications.”