Re: HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study
Dear Editor,
We read with interest the article by McCoy RG et al on over-testing and overtreatment among US adults with controlled type 2 diabetes (1). We were surprised by the significant number of patients who were over-tested and wondered how different the situation is in a UK primary care setting.
We audited the frequency of HbA1c testing in the last 2 years in our large (population size 14,000) urban practice in the north of England. We used a similar definition of ‘stable’ Type 2 Diabetes Mellitus (T2DM) to identity a group of patients who met the current NICE Guidelines (NG28 – T2DM in Adults: Management) which recommends HbA1c testing at 6 months intervals (i.e. two tests a year) (2). We excluded patients with either a new diagnosis of T2DM or those with a change in health status that would require more frequent HbA1c testing. We used our electronic search facility within the computer records to search for HbA1c tests and then reviewed each patient’s electronic records to confirm the data was accurate.
We found a significantly smaller proportion of patients being over-tested: Only 18% (16/89) had more than 2 tests in a 12 month period; the remaining patients had one (35/89) or two (39/89) tests, suggesting that under-testing is more of a potential issues than over-testing. On review of the patient records of those who were over-tested, it appeared this was often due to duplication of tests prior to the diabetes review appointment rather than health professionals or patients requesting additional tests.
Although acknowledging the small numbers in our audit, the difference in proportion of over-testing in patients with Type 2 diabetes is striking compared to the US study. Causes for these differences would need to be evaluated, but the obvious and pertinent supposition must be whether a public sector (NHS) context, compared to a private-driven health system, prevents somewhat over-testing and overtreatment and all the harmful issues than can potentially follow?
References:
1. McCoy RG, Van Houten HK, Ross JS, Montori VM and Shah ND. HBA1c overtesting and overtreatment among US adults with controlled type 2 diabetes. BMJ 2015;351:h6138
2. NICE Guidelines (NG28). Type 2 Diabetes in adults: Management. Dec 2015
Competing interests: No competing interests
Competing interests:
No competing interests
27 February 2016
Harley J Fuller
4th Year Medical Student
Dr Hugh Alberti (General Practitioner)
The Linthorpe Surgery, 378 Linthorpe Rd, Middlesbrough, Cleveland TS5 6HA
Rapid Response:
Re: HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study
Dear Editor,
We read with interest the article by McCoy RG et al on over-testing and overtreatment among US adults with controlled type 2 diabetes (1). We were surprised by the significant number of patients who were over-tested and wondered how different the situation is in a UK primary care setting.
We audited the frequency of HbA1c testing in the last 2 years in our large (population size 14,000) urban practice in the north of England. We used a similar definition of ‘stable’ Type 2 Diabetes Mellitus (T2DM) to identity a group of patients who met the current NICE Guidelines (NG28 – T2DM in Adults: Management) which recommends HbA1c testing at 6 months intervals (i.e. two tests a year) (2). We excluded patients with either a new diagnosis of T2DM or those with a change in health status that would require more frequent HbA1c testing. We used our electronic search facility within the computer records to search for HbA1c tests and then reviewed each patient’s electronic records to confirm the data was accurate.
We found a significantly smaller proportion of patients being over-tested: Only 18% (16/89) had more than 2 tests in a 12 month period; the remaining patients had one (35/89) or two (39/89) tests, suggesting that under-testing is more of a potential issues than over-testing. On review of the patient records of those who were over-tested, it appeared this was often due to duplication of tests prior to the diabetes review appointment rather than health professionals or patients requesting additional tests.
Although acknowledging the small numbers in our audit, the difference in proportion of over-testing in patients with Type 2 diabetes is striking compared to the US study. Causes for these differences would need to be evaluated, but the obvious and pertinent supposition must be whether a public sector (NHS) context, compared to a private-driven health system, prevents somewhat over-testing and overtreatment and all the harmful issues than can potentially follow?
References:
1. McCoy RG, Van Houten HK, Ross JS, Montori VM and Shah ND. HBA1c overtesting and overtreatment among US adults with controlled type 2 diabetes. BMJ 2015;351:h6138
2. NICE Guidelines (NG28). Type 2 Diabetes in adults: Management. Dec 2015
Competing interests: No competing interests
Competing interests: No competing interests