Change in HbA1c as a measure of quality of diabetes care.

(collected the day of the consult or within 90 days prior) was 8.0%, and at least one subsequent A1C, performed after 3 months, was measured. A third A1C was collected in patients who had been seen for 6 months at the time of data collection. The mean SD A1C was calculated for each of the three time points, and a t test was performed to determine statistical significance between levels. A total of 96 patients met the entry criteria. Of these, 54 (56%) had a third data point. The remainder had not yet been followed long enough at the time of data collection (n 32) or did not adhere to follow up (n 9). The mean A1C at entry was 10.36 1.66%. The mean first and second follow-up A1C levels were 8.06 1.68 and 7.68 1.38%, respectively. Changes from entry to first and second A1C were both statistically significant (P 0.001). Seventy-four percent of patients at first follow-up A1C and 80% at the second demonstrated an A1C decline of 1%. In this brief observation, the majority of patients who were referred for endocrine consultation to evaluate and treat poor diabetes control showed clinically meaningful improvements in A1C. In evaluating quality of care, the DPRP looks at a cross section of randomly chosen patients. In a consultation practice, the diabetes specialist may accumulate many poorly controlled patients. Therefore, the impression is that quality of care is poor. Moreover, provider recognition may be less likely under the current scoring system. Yet, the DCCT demonstrated that reductions in microvascular complications, in particular retinopathy, can be seen with sustained A1C reductions even if the target of 7% is not achieved (5). Change in A1C may be a useful marker for quality of care given by diabetes consultants and can be used as an adjunct to the current DPRP standards, especially if longer-term data are used.