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Don't forget QOF in payment by results health systems.
As well as the three main reasons for treating diabetes listed in the article, there is, in England, a driving force that may cloud judgment and clinical common sense, ie QOF. Practice income needed to pay staff and run services depends on hitting targets including HBAic results. This may automatically lead to extra treatment with newer agents, potentially harming people. Those that set QOF targets in diabetes and many other areas seem not to recognise that even in clinical trials most people do not get to or keep at target levels.