Our health insurance provider recently advised me that our seven-year-old son will have to have his A1c test done at a laboratory (separate from his endocrinologist’s office visit). I need to write an appeal letter. Do you have any suggestions that might strengthen my case?

Three studies published in Diabetes Care (citations below) have shown that when patients can discuss their HbA1c reading with their diabetes team during a clinic visit, their blood glucose control improved. This makes sense intuitively. Given how busy families are, and how overbooked most clinics are, if you don’t discuss your HbA1c at the time of the clinic visit, you’re unlikely to discuss it all and therefore you won’t have a chance to make adjustments in care.

In a poll we ran in July 2007, our readers report a growing trend toward finger stick HbA1c testing in the clinic. 59% report finger stick HbA1c testing in the clinic, compared with 49% in March 2003. Yet, 33% report still getting a venous blood draw, compared with 37% in March 2003. Both show a trend toward greater use of HbA1c tests that can be performed immediately in the clinic and which allow patients to discuss the results immediately with their diabetes team.

Citations:

Effect of Point-of-Care on Maintenance of Glycemic Control as Measured by A1C (Diabetes Care 30:713-715, 2007)
Immediate feedback of HbA1c levels improves glycemic control in type 1 and insulin-treated type 2 diabetic patients (Diabetes Care, Vol 22, Issue 11 1785-1789)
Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic (Diabetes Care 26:1158-1163, 2003)

JSH