Improving patients’ knowledge on the relationship between HbA1c and mean plasma glucose improves glycaemic control among persons with poorly controlled diabetes

Ann Clin Biochem 2008;45:504-507
© 2008 Association for Clinical Biochemistry



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Original Articles

Nosheen Iqbal,
Catherine Morgan,
Hisham Maksoud and
Iskandar Idris

Department of Diabetes and Endocrinology, Sherwood Forest Hospitals Foundation Trust, Nottinghamshire, UK

Corresponding author: Dr Iskandar Idris. Email: iidris{at}

Background: Recent recommendation advocates the reporting of HbA1c in termsof mean plasma glucose. We examined the impact of improvingpatients’ interpretation of a given HbA1c value on glycaemiccontrol.

Methods: We conducted a questionnaire survey among 111 patients attendinga hospital diabetes clinic. Patients were provided with informationrelating to the association between HbA1c and mean plasma glucoselevels. Glycaemic control among 80 patients with poor glycaemiccontrol was assessed before and approximately seven months aftersuch intervention.

Results: Of the respondents, 40.5% (45/111) were familiar (F) (31 type 1, 14 type 2) and 59.5% (66/111) were unfamiliar (U) (23 type 1, 43 type 2) with the term HbA1c. Following information about the interpretation of HbA1c, patients with poorly controlled diabetes (HbA1c >9%) showed a significant reduction in HbA1c levels if they were from group U (10.7% vs. 9.5%, P = 0.04) but not from group F (10.5 vs. 9.8, P = 0.28). Patients with moderately poor glycaemic control (HbA1c 7.5–9%) showed no significant change in HbA1c levels following intervention (8.3% vs. 8.2%, P = 0.57 group U; 8.3% vs. 8.2%, P = 0.79 groupF).

Conclusion: Patients’ knowledge of HbA1c is poor, especially among personswith type 2 diabetes. Improvement in patients’ understandingof HbA1c, particularly among those with very poorly controlleddiabetes with no prior knowledge of HbA1c is associated withimprovement in their glycaemic control. Strategies to engagepatients to know and interpret their HbA1c values should beencouraged within routine clinical practice.

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