The inappropriate use of HbA1c testing to monitor glycemia: is there evidence in laboratory data?

Akan, Pınar; Çımrın, Dilek; Örmen, Murat; Küme, Tuncay; Ozkaya, Aygul; Ergör, Gül; Abacioglu, Hakan

doi:10.1111/j.1365-2753.2006.00641.x

Cited by 21 publications

(11 citation statements)

References 24 publications

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“…This prevalence is consistent with previous estimates of overrequesting in general (1-3 ) and in DM in particular (17)(18)(19). For the first time, we also assessed the prevalence of underrequesting.…”

Section: Discussionsupporting

confidence: 77%

“…Our findings on overrequesting are consistent with those of Salvagno et al (17 ), who showed that repeat testing within 3 months was higher in inpatients (particularly with Hb A 1c values of Ͻ7%) than outpatients (particularly with values of Ͼ7%), although it should be stressed that interpretation of the inpatient data with definitive cutoffs (Table 1) should be treated with caution, as illustrated by the relative-frequency plots. Similarly, Akan et al (19 ) showed that overrequesting was more common in inpatients than outpatients and, in the latter group, in those with an Hb A 1c Ͻ7%. Neither study examined underrequesting or the effect of age.…”

Section: Discussionmentioning

confidence: 88%

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Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

et al. 2012

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BACKGROUND:Estimates suggest that approximately 25% of requests for pathology tests are unnecessary. Even in diabetes, for which international guidance provides recommended testing frequency, considerable variability in requesting practice exists. Using the diabetes marker, Hb A 1c , we examined (a) the prevalence of under-and overrequesting, (b) the impact of international guidance on prevalence, and (c) practice-to-practice variability.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 88%

Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

et al. 2012

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“…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).…”

Section: Introductionmentioning

confidence: 99%

The frequency of testing for glycated haemoglobin, HbA_1c, is linked to the probability of achieving target levels in patients with suboptimally controlled diabetes mellitus

Duff

Solis-Trapala

Driskell

et al. 2018

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background We previously showed, in patients with diabetes, that >50% of monitoring tests for glycated haemoglobin (HbA1c) are outside recommended intervals and that this is linked to diabetes control. Here, we examined the effect of tests/year on achievement of commonly utilised HbA1c targets and on HbA1c changes over time. 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 effect of HbA1c tests/year on (i) the probability of achieving targets of ≤53 mmol/mol (7%) and ≤48 mmol/mol (6.5%) in a year using multi-state modelling and (ii) the changes in mean HbA1c using a linear mixed-effects model. Results The probabilities of achieving ≤53 mmol/mol (7%) and ≤48 mmol/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 four tests/year, having one test or more than four tests/year were associated with lower likelihoods of achieving either target; two to three tests/year gave similar likelihoods to four tests/year. Mean HbA1c levels were higher in patients who had one test/year compared to those with four tests/year (mean difference: 2.64 mmol/mol [0.24%], p<0.001). Conclusions We showed that ≥80% of patients with suboptimal control are not achieving commonly recommended HbA1c targets within 1 year, highlighting the major challenge facing healthcare services. We also demonstrated that, although appropriate monitoring frequency is important, testing every 6 months is as effective as quarterly testing, supporting international recommendations. We suggest that the importance HbA1c monitoring frequency is being insufficiently recognised in diabetes management.

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“…Recent reports suggest that guidelines are not necessarily being followed; [14], [16], [17], [18], [19] for example in one UK trust 21% of all HbA1c tests were performed more frequently than guidelines recommend [17]. Over 80% of these requests came from primary care and over two thirds of the more frequent requests were for patients who had well-controlled diabetes.…”

Section: Introductionmentioning

confidence: 99%

Changes in HbA1c Level over a 12-Week Follow-up in Patients with Type 2 Diabetes following a Medication Change

2014

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BackgroundCurrent guidance about the interval needed before retesting HbA1c when monitoring for glycaemic control is based on expert opinion rather than well-powered studies. The aim of our work was to explore how fast HbA1c changes after a change in glucose-lowering medication. This has implications for whether routine HbA1c testing intervals before 12 weeks could inform diabetes medication adjustments.MethodsThis 12-week cohort study recruited patients from 18 general practices in the United Kingdom with non-insulin treated diabetes who were initiating or changing dose of oral glucose-lowering medication. HbA1c was measured at baseline and 2, 4, 8 and 12 weeks after recruitment. HbA1c levels at earlier time intervals were correlated with 12-week HbA1c. A ROC curve analysis was used to identify the 8-week threshold above which medication adjustment may be clinically appropriate.ResultsNinety-three patients were recruited to the study. Seventy-nine patients with no change in medication and full 12-week follow-up had the following baseline characteristics: mean±standard deviation age of 61.3±10.8 years, 34% were female and diabetes duration of 6.0±4.3 years. Mean HbA1c at baseline, 2, 4, 8 and 12 weeks was 8.7±1.5%, (72.0±16.8 mmol/mol) 8.6±1.6% (70.7±17.0 mmol/mol), 8.4±1.5% (68.7±15.9 mmol/mol), 8.2±1.4% (66.3±15.8 mmol/mol) and 8.1±1.4% (64.8±15.7 mmol/mol) respectively. At the end of the study 61% of patients had sub-optimal glycaemic control (HbA1c>7.5% or 59 mmol/mol). The 8-week change correlated significantly with the 12-week change in HbA1c and an HbA1c above 8.2% (66 mmol/mol) at 8 weeks correctly classified all 28 patients who had not achieved glycaemic control by 12 weeks.Conclusions/interpretationThis is the first study designed with sufficient power to examine short-term changes in HbA1c. The 12-week change in HbA1c can be predicted 8 weeks after a medication change. Many participants who had not achieved glycaemic control after 12 weeks may have benefitted from an earlier review of their HbA1c and medication.

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The inappropriate use of HbA1c testing to monitor glycemia: is there evidence in laboratory data?

Abstract: Inappropriate laboratory utilization of HbA1c testing is very common especially in the inpatient clinics. We think that the application of the guidelines may decrease unnecessary health expenditure.

Cited by 21 publications

References 24 publications

Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

The frequency of testing for glycated haemoglobin, HbA_1c, is linked to the probability of achieving target levels in patients with suboptimally controlled diabetes mellitus

Changes in HbA1c Level over a 12-Week Follow-up in Patients with Type 2 Diabetes following a Medication Change

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The inappropriate use of HbA1c testing to monitor glycemia: is there evidence in laboratory data?

Abstract: Inappropriate laboratory utilization of HbA1c testing is very common especially in the inpatient clinics. We think that the application of the guidelines may decrease unnecessary health expenditure.

Cited by 21 publications

References 24 publications

Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

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

Changes in HbA1c Level over a 12-Week Follow-up in Patients with Type 2 Diabetes following a Medication Change

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The frequency of testing for glycated haemoglobin, HbA_1c, is linked to the probability of achieving target levels in patients with suboptimally controlled diabetes mellitus