Duff, C, Solis-Trapala, I ORCID: 0000-0002-1264-1396, Driskell, O, Holland, D, Wright, H, Waldron, J, Ford, C, Scargill, J, Tran, M, Hanna, F, Pemberton, J, Heald, A and Fryer, A (2018) The frequency of testing for glycated hemoglobin, HbA1c, is linked to the probability of achieving target levels in patients with sub-optimally controlled diabetes mellitus. Clinical Chemistry and Laboratory Medicine. ISSN 1437-4331

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20180926_trappala_Duff et al CCLM 2018 accepted version.pdf - Accepted Version
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Abstract

Introduction:
We previously showed, in patients with diabetes, that >50% of monitoring tests for glycated hemoglobin (HbA1c) are outside recommended intervals and that this is linked to diabetes control. Here, we examined the impact of tests/year on achievement of commonly-utilised HbA1c targets and on HbA1c changes over time.

Subjects & Methods:
Data on 20,690 adults with diabetes with a baseline HbA1c of >53 mmol/mol (7%) were extracted from Clinical Biochemistry Laboratory records at three UK hospitals. We examined the impact of HbA1c tests/year on: (i) probability of achieving targets of ≤53mmol/mol (7%) and ≤48mmol/mol (6.5%) in a year using multi-state modelling and (ii) changes in mean HbA1c using a linear mixed-effects model.

Results:
The probabilities of achieving ≤53mmol/mol (7%) and ≤48mmol/mol (6.5%) targets within 1 year were 0.20 (95% confidence interval:0.19-0.21) and 0.10 (0.09-0.10), respectively. Compared with 4 tests/year, having 1 test or >4 tests/year were associated with lower likelihoods of achieving either target; 2-3 tests/year gave similar likelihoods to 4 tests/year. Mean HbA1c levels were higher in patients who had 1 test/year compared to those with 4 tests/year (mean difference: 2.64mmol/mol [0.24%], p<0.001).

Conclusions:
We showed that ≥80% of patients with sub-optimal control are not achieving commonly recommended HbA1c targets within 1 year, highlighting the major challenge facing healthcare services. We also demonstrated that, while appropriate monitoring frequency is important, 6-monthly testing is as effective as quarterly testing, supporting international recommendations. We suggest that the importance HbA1c monitoring frequency is being insufficiently recognised in diabetes management.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via De Gruyter at https://doi.org/10.1515/cclm-2018-0503 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: glycated hemoglobin, diabetes mellitus, test utilization, monitoring, glycaemic 3 target
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 26 Sep 2018 09:41
Last Modified: 12 Oct 2018 10:58
URI: http://eprints.keele.ac.uk/id/eprint/5319

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