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

Driskell, Owen J; Holland, David; Hanna, Fahmy; Jones, Peter W.; Pemberton, R. John; Tran, Martin; Fryer, Anthony A.

doi:10.1373/clinchem.2011.176487

Cited by 78 publications

(67 citation statements)

References 16 publications

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“…However, we found no previous work examining potential predictors for receiving more frequent annual HbA1c checks in patients with type 1 diabetes, such as those reported here (e.g., CSII and care unit). Recent studies of the frequency of HbA1c measurements in patients with type 2 diabetes or without specifying the type of diabetes, have reported that HbA1c checks are underused in the UK and Australia, without generally examining various predictors for more frequent HbA1c checks [21,22].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study in 5,989 Patients with Type 1 Diabetes in 10 Outpatient Diabetes Clinics in Sweden of the Frequency of Measuring HbA1c in Clinical Practice

Matuleviciene¹

2014

J Diabetes Metab

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Aim: Guidelines for the treatment of type 1 diabetes generally recommend quarterly or more frequent Haemoglobin A1c (HbA1c) assessment in patients with inadequate glycaemic control. The purpose of the current study was to evaluate to what extent these guidelines are followed in clinical practice in Sweden. Method:We studied 5989 patients with type 1 diabetes from 10 outpatient diabetes clinics in Sweden from 1 January 2005 to 31 December 2009. Data on HbA1c measurement frequency were obtained from the Diab-Base electronic medical records database, where HbA1c measurements are recorded together with other patient characteristics, including treatment and other general risk factors for diabetic complications. The frequency of HbA1c measurements was obtained for all patients by calendar year, care unit, and during time periods where glucose was classified as well controlled (HbA1c<=7.0%) or inadequate (HbA1c 7.0% or higher). Results:The mean annual number of HbA1c assessments when glucose control was inadequate was 1.83 compared with 1.58 during well controlled time-periods. In 35.4% of cases the next HbA1c check following an HbA1c >7% was performed within 4 months. The probability of a subsequent assessment in the 4 months following an HbA1c value>7.0% increase in patients treated with continuous subcutaneous insulin infusion (CSII), OR=1.57 (1.46-1.69). Differences were also noted by care unit, age, gender, glycaemic control, calendar year, and weight and diabetes duration. Conclusion:In patients with type 1 diabetes, HbA1c is measured less frequently in clinical practice in Sweden than guidelines recommend, although patients with CSII and treated in certain care units receive more frequent assessments.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Study in 5,989 Patients with Type 1 Diabetes in 10 Outpatient Diabetes Clinics in Sweden of the Frequency of Measuring HbA1c in Clinical Practice

Matuleviciene¹

2014

J Diabetes Metab

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“…On top of this hierarchy are assessments of the effect of analytical performance on clinical decision-making (outcome studies), second professional recommendations, third quality specifications laid down by regulation or external quality assessment scheme (EQAS) organizers and last, published data on the state-of-the-art. It is not surprising, that most work for setting quality specifications even lower in hierarchy than HTA or the good use of laboratory medicine (GULM) has been done so far on 'simple chemical tests' such as electrolytes, glucose, or Hb A1c [4] leaving wide areas of laboratory medicine without widely-accepted recommendations [5] and the practical use of these recommendations has not reached the whole area of laboratory medicine due to numerous reasons, most of them not under sufficient control of the people working in the laboratory.…”

Section: Hta and Stockholm Recommendationsmentioning

confidence: 99%

Are regulation-driven performance criteria still acceptable? – The German point of view

Orth¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Performance criteria should be a challenge for the laboratories to improve their quality. In countries with mandatory proficiency testing, the definition of performance criteria is a particular issue. If the definition of performance criteria is mandated from the regulatory bodies to medicoscientific institutions, scientific approaches (i.e., based on biological variation), the state-of-the-art approach (i.e., based on technical feasibility) as well as medical needs can be used to set up performance criteria such as the Richtlinie der Bundesärztekammer (RiliBÄK; Guideline of the German Medical Association on Quality Assurance in Medical Laboratory Examinations) in Germany. The experiences with RiliBÄK show that these performance criteria have to be revised on an ongoing basis.

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“…Diabetic patients ' participation in disease management programs is also associated with lower medical costs [ 92 ]. A recent paper by Driskell et al highlighted that glycated hemoglobin assays were inappropriately prescribed in 50% of cases [ 93 ], and this justifies the correct use of markers of glycemic control such as HbA 1c for predicting all types of cost-generating complications. This applies to both short-and long-term costs [ 94 ].…”

Section: Diabetes and Laboratory Managementmentioning

confidence: 99%

Glycemic control in the clinical management of diabetic patients

Mosca

Lapolla

Gillery

2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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In clinical practice, glycemic control is generally assessed by measuring and interpreting glycated hemoglobin levels, however, this test should be run under standardized conditions. We focus here on the crucial steps to ensure IFCC standardized HbA 1c results, pointing out several residual weak points, mostly relating to the laboratory end-user (calibration, quality control materials, and EQAS). We also review the use of HbA 1c for diagnosing diabetes and the various indicators useful for assessing glucose variability because in some cases they seem to represent a patient ' s glucose profile more accurately than one-off HbA 1c assays. Finally, the potential utility of glycated albumin and the glycation gap, the costs involved and the laboratory management issues are briefly discussed.

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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

Cited by 78 publications

References 16 publications

A Retrospective Study in 5,989 Patients with Type 1 Diabetes in 10 Outpatient Diabetes Clinics in Sweden of the Frequency of Measuring HbA1c in Clinical Practice

A Retrospective Study in 5,989 Patients with Type 1 Diabetes in 10 Outpatient Diabetes Clinics in Sweden of the Frequency of Measuring HbA1c in Clinical Practice

Are regulation-driven performance criteria still acceptable? – The German point of view

Glycemic control in the clinical management of diabetic patients

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