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The Relationship Between Knowledge of Recent HbA_1c Values and Diabetes Care Understanding and Self-Management

¹ Veterans Affairs Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
² Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
³ Michigan Diabetes Research and Training Center, University of Michigan School of Medicine, Ann Arbor, Michigan
⁴ University of Michigan School of Social Work, Ann Arbor, Michigan

Address correspondence and reprint requests to Michele Heisler, HSR&D Field Program, P.O. Box 130170, 11H, Ann Arbor, MI 48113. E-mail: mheisler{at}umich.edu

OBJECTIVE—Knowledge of one’s actual and target health outcomes (such as HbA_1c values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one’s most recent HbA_1c test result and 2) whether knowing one’s HbA_1c value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control.

RESEARCH DESIGN AND METHODS—We conducted a cross-sectional survey of a sample of 686 U.S. adults with type 2 diabetes in five health systems who had HbA_1c checked in the previous 6 months. Independent variables included patient characteristics, health care provider communication, and health system type. We examined bivariate and multivariate associations between each variable and the respondents’ knowledge of their last HbA_1c values and assessed whether knowledge of HbA_1c was associated with key diabetes care attitudes and behaviors.

RESULTS—Of the respondents, 66% reported that they did not know their last HbA_1c value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA_1c knowledge. Respondents who knew their last HbA_1c value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05–2.42) and better reported understanding of their diabetes care (P < 0.001). HbA_1c knowledge was not associated with respondents’ diabetes care self-efficacy or reported self-management behaviors.

CONCLUSIONS—Respondents who knew their HbA_1c values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one’s HbA_1c level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients’ diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes.

Abbreviations: AMC, academic medical center • PCP, primary care provider • VA, Veterans Affairs

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