Christopher J. Duff
The frequency of testing for glycated haemoglobin, HbA1c, is linked to the probability of achieving target levels in patients with suboptimally controlled diabetes mellitus.
Duff, Christopher J.; Solis-Trapala, Ivonne; Driskell, Owen J.; Holland, David; Wright, Helen; Waldron, Jenna L.; Ford, Clare; Scargill, Jonathan J.; Tran, Martin; Hanna, Fahmy W.F.; Pemberton, R. John; Heald, Adrian; Fryer, Anthony A.
Authors
Ivonne Solis-Trapala i.solis-trapala@keele.ac.uk
Owen J. Driskell
David Holland
Helen Wright
Jenna L. Waldron
Clare Ford
Jonathan J. Scargill
Martin Tran
Fahmy W.F. Hanna
R. John Pemberton
Adrian Heald
Professor Anthony Fryer a.a.fryer@keele.ac.uk
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.
Journal Article Type | Article |
---|---|
Acceptance Date | Sep 4, 2018 |
Online Publication Date | Oct 2, 2018 |
Publication Date | Oct 2, 2018 |
Publicly Available Date | May 26, 2023 |
Journal | Clinical Chemistry and Laboratory Medicine |
Print ISSN | 1434-6621 |
Publisher | De Gruyter |
DOI | https://doi.org/10.1515/cclm-2018-0503 |
Keywords | glycated hemoglobin, diabetes mellitus, test utilization, monitoring, glycaemic 3 target |
Publisher URL | https://doi.org/10.1515/cclm-2018-0503 |
PMID | 30281512 |
Files
20180926_trappala_Duff et al CCLM 2018 accepted version.pdf
(563 Kb)
PDF
Publisher Licence URL
https://creativecommons.org/licenses/by-nc/4.0/
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