Clinical Question: Does a rapid assay for glycated hemoglobin improve outcomes and save money?

Setting: Outpatient (primary care)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Eight primary care practices in England recruited 681 adult patients with type 2 diabetes to be randomized to receive usual care or to have a finger-stick rapid glycated hemoglobin assay during an office visit. After one year, the researchers assessed how many patients achieved good glycemic control (defined as a glycated hemoglobin level of less than 7 percent) and the costs of care. These were analyzed by intention to treat. The final analysis was based on data from more than 90 percent of the patients (i.e., those who completed the study and had data). At the end of the year, there was no difference in glycemic control compared with the baseline glycated hemoglobin values. There also was no difference in the cost of diabetes-related care between the two groups.

Bottom Line: Rapid testing of glycated hemoglobin in office settings does not save money or improve glycemic control compared with usual care. (Level of evidence: 2b)