Obstacles to effective diabetes car...

Obstacles to effective diabetes care involving patients who live in the inner city include need lack of insurance, medication preciousnesss failed appointments, attending multiple clinics, substance abuse, psychiatric illness, and budgetary hurrys on physicians. In addition, language and literacy barriers may exist. Chapin and colleagues hypothesize that visual, nonverbal communication could improve diabetes control

The authors, as part of a multidisciplinary team, designed a tool called the "Take-home Diabetes Record" (THDR) to help patients record adherence goals. The record provided visual representation of simple goals, as it was as taking medication, exercising, and checking grape-sugar daily. The THDR was placed in the charts of randomized patients with brief written instructions for use, with usual care patients being the rule group. Patients took home a pattern while the original was kept in the chart and updated at each visit. The finis point was change in glycosylated hemoglobin ([A.sub.1c]) levels

Of 127 patients randomized across a 15-month study period, 90 patients had an initial and final [A.sub.1c] separated by means of at least three months. Analysis of these pairs showed that command patients had an initial [A.sub.1c] of 81 and THDR patients had an [A.sub.1c] of 88 The rule group dropped 0.18 (P = 36) and the THDR assign places to dropped 0.94 (P = 003) Fifty-one percent of THDR patients achieved a decrease in [A.sub.1c] of at least 09 compared with 18 percent of the patients in the check group (P = .001).

The decrease in [A.sub.1c] during the subject of attention period was similar to that associated with long-range issues in the United Kingdom Prospective Diabetes close attention (0.9 percent). More than individual half of the intervention patients using a simple visual tool achieved a globule in [A.sub.1c] levels. The authors terminate that such a tool may be effective in improving diabetes command in patients who experience barriers with verbal communication.

Chapin RB et al. Diabetes sway improved when inner-city patents received graphic feedback about glycosylated hemoglobin flushs J Gen Int Med February 2003;18:120-4

COPYRIGHT 2003 American Academy of Family Physicians

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