This editorial, and most of the rapid reponses to date seem to ignore
the fact that the QOF only asks that a practice ensures 50% of it's
registered population of diabetics has an HbA1c of less than or equal to
7.0%. Whilst I accept that ACCORD, and to some extent VADT, showed it is
harmful for those with long standing diabetes or a previous history of
cardiovascular disease to have their HbA1c driven to a target of <6.0%
(the goal in ACCORD), this is a very different target to the 7.0% or less
being asked for by the QOF. The 10 year follow up data from UKPDS
conversely showed a lasting benefit from intensive early treatment of
newly diagnosed diabetics.
General Practitioners are nothing if not pragmatic, and I would hope that
this attribute will result in an attempt to get the relatively newly
diagnosed diabetics on little or no oral hyoglycaemic therapy to 7.0% or
less, but a realism that for those with long standing, difficult to
control diabetes, the aim of 7.0% or less can be ignored. This way, the
target of 50% can still be acheived, without the potential of harming
those for whom it would be inappropriate.
Competing interests:
None declared
Competing interests:
No competing interests
13 March 2009
Richard A Brice
GP
Whitstable Medical Practice, Whitstable, Kent, CT5 1BZ
Rapid Response:
In defence of QOF targets
This editorial, and most of the rapid reponses to date seem to ignore
the fact that the QOF only asks that a practice ensures 50% of it's
registered population of diabetics has an HbA1c of less than or equal to
7.0%. Whilst I accept that ACCORD, and to some extent VADT, showed it is
harmful for those with long standing diabetes or a previous history of
cardiovascular disease to have their HbA1c driven to a target of <6.0%
(the goal in ACCORD), this is a very different target to the 7.0% or less
being asked for by the QOF. The 10 year follow up data from UKPDS
conversely showed a lasting benefit from intensive early treatment of
newly diagnosed diabetics.
General Practitioners are nothing if not pragmatic, and I would hope that
this attribute will result in an attempt to get the relatively newly
diagnosed diabetics on little or no oral hyoglycaemic therapy to 7.0% or
less, but a realism that for those with long standing, difficult to
control diabetes, the aim of 7.0% or less can be ignored. This way, the
target of 50% can still be acheived, without the potential of harming
those for whom it would be inappropriate.
Competing interests:
None declared
Competing interests: No competing interests