HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study

Of 31,545 patients in the study cohort, HbA1c testing frequency was excessive in 6% and frequent in 55%. Despite good glycaemic control at baseline, treatment was further intensified by addition of glucose lowering drugs or insulin in 8.4% of patients.

An editorial notes that if there is a desire to treat the numbers rather than the patient, more attention should be paid to the absolute risk reductions likely to follow from tests and treatments and less attention to isolated measures such as HbA1c.

 

Recent NICE guidance on type 2 diabetes recommends the adoption of an individualised approach to diabetes care that is tailored to the needs and circumstances of patients, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long term interventions because of reduced life expectancy. Such an approach is especially important in the context of multimorbidity. The person's needs and circumstances should be assessed at each review and consideration given to stopping any medicines that are not effective.