Six-monthly HbA1c tests in diabetes 'unnecessary'

[Pumper_Sue]

GPs do not need to test blood glucose in patients with stable diabetes every six months, as recommended by NICE, as it leads to a high rate of false positives an NHS report has concluded.

Annual monitoring would give more meaningful information on changes to HbA1c which for most people happen quite slowly, the NHS Diabetes report said.

Statistical modelling showed for patients whose HbA1c is currently 56mmol/mol, six-monthly monitoring would pick up 405 positive tests per 1,000 patients ? that is HbAlc readings above 58.5 mmol/mol - but 28% of those would be due to measurement variation and not a real increase.

For the same group of patients annual monitoring would pick up 479 per 1,000 patients but with only 16% would be false positives, the University of Oxford researchers who did the analysis found.

http://www.pulsetoday.co.uk/clinica...ests-in-diabetes-unnecessary/20000846.article Pulse you might need to register to read the full article.

That's all very well if you have access to test strips which many type 2's do not have

 

[MaryPlain]

GPs do not need to test blood glucose in patients with stable diabetes every six months, as recommended by NICE, as it leads to a high rate of false positives an NHS report has concluded.

Ah, but that does beg the question - if you don't test, how do you know it's stable?

 

[trophywench]

And what has stability in A1c got to do with your blood sugar control, may I enquire? LOL

Great that all the 1.8s you have had reduced all the 33.3s to an A1c of 7.5. that means you have brill control already and just need to tweak a little and get the 33.3s down to 30's and the 1.8s up to 2,2s and you'll be 100% fine with no die-abetic complications.

You incredibly STUPID people.

Oh sorry you are at Oxford, so that means you are beyond reproach.

Just like 'Farmer et al' .........

 

[Copepod]

While I agree that it's possible to have a "healthy" HbA1c, with an unhealthy range of hypoglycaemia and hyperglycaemia, this study is just comparing 6 monthly HbA1c and yearly HbA1c - and concludes that 6 monthly is no better than yearly.

I suspect that the researchers' definition of stable diabetes concerns the stability of the condition ie not changing with roughly the same levels of diet and exercise, plus the same medication. Unstable would imply that a new level of treatment, such as adding injecable such as Byetta or Victoza or insulin to oral medication.

The question of home blood glucose testing for people with type 2 diabetes is different, and personally I feel that it's important for people to be able to test to see how certain foods, activities etc affect them, which probably means more testing in early days, with fewer tests needed once people know how things affect them.

 

[HelenM]

Just like 'Farmer et al' .........

Funny you should say that. Where do you think they got the data from for this statistical exercise ?

We used data from the Diabetes Glycaemic Education and Monitoring (DiGEM) study (8) to assess different
sources of variation in HbA1c in people with type 2 diabetes: between-person variation, within-measurement (i.e. laboratory) variation, changes over time in an individual, and the variation between people in the time trends.

ie Farmer A, Wade A, Goyder E, Yudkin P, French D, Craven A, et al. Impact of self monitoring of blood glucosein the management of patients with non-insulin treated diabetes: Open parallel group randomised trial.
Br Med J. 2007;335(7611):132-6.

They are looking at rises not falls, the average change is upwards but this is relatively slow (ie 50mmol/mol to 50.6 mmol/mol in six months so clinically insignificant and a false positive might trigger an unnecessary change in medication.
There is no consideration of the concept that people can make changes and that an HbA1c will either confirm the changes or show that these changes aren't working.


Just another thought:
It does say that 12 monthly testing should apply to people who are stable but it seems that some people are only being tested at 12 months now, some people who report this on forums are newly diagnosed.
The recent joint paper from the European and US associations suggests a three month period of diet and exercise, then if that isn't working 3 months with a two drug combination then check etc. This demands 3 monthly testing at least at the beginning.
http://www.epccs.eu/home/ada-easd-new-hyperglycemia-management-guidelines

 

[trophywench]

Oh that explains a lot, doesn't it.

That original piece of research is so flawed from concept to conclusion it never fails to make my blood boil. Why bother with it, what a waste of time and money. an insult to the intelligence of a diabetic dog, let alone humans.

Which could perchance be the cause of depression for some diabetic people!

ROFLMAO

need a 'Bangs head on wall' smiley, Joe .....

 

[mcdonagh47]

Funny you should say that. Where do you think they got the data from for this statistical exercise

guidelines[/url]

Farmer has published another Meta analysis of self-testing in T2s not on insulin just this year. And it has a brilliantly silly, contradictory conclusion ...

"Evidence from this meta-analysis of individual patient data was not convincing for a clinically meaningful effect of clinical management of non-insulin treated type 2 diabetes by self monitoring of blood glucose levels compared with management without self monitoring, although the difference in HbA(1c) level between groups was statistically significant."

The mean HbA1cs dropped by 2.7 at six months in T2s who were testing, that's "statistically significant" but "not convincing" ????????????
Which planet is this Farmer from ? Perhaps he should stick to ploughing.

Anyway I'm going to quote this result out of context from now on ...i.e.

A meta analysis of six studies involving 2552 "non-insulin treated type 2 diabetes by self monitoring of blood glucose levels compared with management without self monitoring ...found ... the difference in HbA(1c) level between groups was statistically significant."
Farmer et al 2012.
http://www.ncbi.nlm.nih.gov/pubmed/22371867

 

[DeusXM]

My reading of this was an essential admission that the A1C test is not absolutely accurate.

In 'old money', the report is basically saying that in just over a quarter of cases, someone with an A1C of 7.3% could get a reading of 7.5%, which could be interpreted as control getting worse, whereas it might actually be exactly the same.

I would draw a rather different conclusion from this discovery - namely that the A1C should still be the ballpark measure of control but it requires supplementary data to be of use ie. offering regular meter testing to ALL those with diabetes. And potentially, double checking the A1c results with perhaps multiple draws averaged out. Or alternatively, they could just do what I've always done - get one every six months and then largely ignore changes of 0.2% as not really worth worrying about until they show up repeatedly.

 

[Andy HB]

I'm coming up for my next HbA1c and, to be honest, was thinking about asking the surgery to make it every 12months rather than 6monthly. The thing is that I do have access to a small number of test strips (my pot of 50 lasts me over a year!) and my weekly tests continue to indicate my BG levels are Ok.

So, I would argue that people in a similar position to me and who have access to test strips, a 12 monthly HbA1c is not such a stupid idea. But as has already been said, getting access to test strips is rather difficult. I've just changed surgeries and the new GP won't give me a repeat prescription like my old one did but will give me a prescription when I ask for one (seems a bit daft to me, but hey!).

Andy 🙂