Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines?

Abstract

Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.

Primary care management post gestational diabetes in Australia

“…Monitoring lipids among patients with type 2 diabetes in rural Australia found that 30.6% did not obtain their annual lipid tests. 19 Our findings are consistent with these results and indicate that despite guidelines and persistent public health efforts to highlight the need for diabetes testing and cardiovascular risk screening among people at risk, the rate of testing has further to improve in Australian primary care. The higher levels of BP measurement, compared with other risk factors, could be because BP testing is simple and accessible, sphygmomanometers are readily available and GP guidelines encourage routine BP measurements.…”

“…Monitoring lipids among patients with type 2 diabetes in rural Australia found that 30.6% did not obtain their annual lipid tests 19 . Our findings are consistent with these results and indicate that despite guidelines and persistent public health efforts to highlight the need for diabetes testing and cardiovascular risk screening among people at risk, the rate of testing has further to improve in Australian primary care.…”

The association of socioeconomic disadvantage and remoteness with receipt of type 2 diabetes medications in Australia: a nationwide registry study

“…Implications Insulin and sulfonylureas, both of which carry a greater risk of hypoglycaemia than newer GLDs [29,30], were more common in remote areas than major cities. Disparate utilisation of the best available medications in remote areas, which may be in part due to disparate access to healthcare [31][32][33], may contribute to the worse mortality and health outcomes in these areas [10]. Therefore, efficient dissemination of newer medications may be an appropriate intervention to address health disparity for people in remote and disadvantaged areas of Australia.…”

The frequency of testing for glycated haemoglobin, HbA1c, is linked to the probability of achieving target levels in patients with suboptimally controlled diabetes mellitus

“…8%]) and 1-year (58.5 mmol/mol[7.5%]) HbA1c values. In the study by Paul et al(10), only 18.5% of cases with a baseline HbA1c of >53 mmol/mol (>7%) had a subsequent test result below 53 mmol/mol (7%) over the 2 year follow-up period. Hence, in spite of the resources put into diabetes management, many patients remain above target HbA1c, with all the attendant adverse long-term health consequences for the individual(22)(23)(24).Impact of monitoring frequency.…”

“…While guidance on monitoring frequency is clear, studies have shown that many patients do not have tests at the recommended frequency (4)(5)(6)(7)(8)(9)(10)(11). For example, a Australian study (10) showed that, of patients with HbA1c >53 mmol/mol (>7%), only 22.9% received a follow-up test within the recommended 3-monthly interval over the 24 month study period, while we showed that >50% of all tests are requested outside recommended monitoring intervals (21% too soon; 30% too late) (7). We have observed this phenomenon in other cases where scheduled testing is required (12).…”