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Testing patients with diabetes

Annual HbA1c and albumin/creatinine ratio are important for people with diabetes

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Key points:

  • Ensure that all your patients with diabetes have at least an annual HbA1c and albumin/creatinine ratio
  • Ensure self-monitoring of blood glucose(SMBG) is not being used to replace the annual diabetes review
  • Patients who are not taking any diabetic medications and self monitor, are less likely to have albumin/ creatinine ratio and HbA1c testing

Nationally, approximately 12% of people with diabetes are not having an annual HbA1c while 26% are not having an annual albumin/creatinine ratio.

It is recommended that all patients with diabetes have an annual diabetic review, which includes testing HbA1c and albumin/creatinine ratio. Albumin/creatinine ratio should be checked at least once a year and the HbA1c tested two to four times a year, depending on the patients glycaemic control.

People with diabetes treated with insulin, metformin or sulphonylureas are more frequently tested than those controlled by diet alone.

For people with diabetes controlled by diet, up to 20% have not had an annual HbA1c and up to 35% have not had an annual albumin/creatinine ratio.

Review of laboratory data shows that people with diabetes who are controlled by diet alone and are also performing SMBG, are less likely (P < 0.01) to have had an annual check of their HbA1c and albumin/creatinine ratio.

This is a significant concern as using SMBG as the ongoing marker of glycaemic control is not adequate. Rather the recommended annual tests, which provide a more accurate overall picture of glycaemic status as well as better information about the likelihood of the longterm consequences of diabetes, should be used.

Role of SMBG for people with type 2 diabetes

The effectiveness of SMBG in improving glycaemic control in people with type 2 diabetes who are not on insulin has not been consistently demonstrated. In the majority of recent trials SMBG has not been found to be clinically beneficial and in some people may be associated with a reduction in quality of life.

SMBG may be appropriate and clinically useful for people with type 2 diabetes in the following clinical situations:

  • Patients on insulin, or prior to initiation of insulin
  • Newly diagnosed patients for a short period of time to inform and educate about the relationship between diet, exercise and blood sugar
  • During periods of glycaemic instability, e.g. illness, medication change, intense physical activity
  • To optimise glycaemic control prior to conception and during pregnancy

For SMBG to be clinically effective in these situations the doctor and patient should agree on a clear purpose and goals for the self

Testing of your patients with diabetes

All patients with diabetes

National Rate
xx% have had at least one albumin/creatinine ratio during the year 74%
xx% have had at least one HbA1c test during the year 88%
Please note: We are unable to identify people with diabetes, controlled by diet alone, and who are not performing self-monitoring, and therefore they are not included in this report.

Patients on insulin

National Rate
xx% have had at least one albumin/creatinine ratio during the year 75%
xx% have had at least one HbA1c test during the year 88%
Please note: some figures may be underestimated, if tests have been performed in a diabetes clinic, and therefore not available from NZHIS lab warehouse.

Patients on metformin or sulphonylureas

National Rate
xx% have had at least one albumin/creatinine ratio during the year 75%
xx% have had at least one HbA1c test during the year 89%

Patients controlled by diet

National Rate
xx% have had at least one albumin/creatinine ratio during the year 65%
xx% have had at least one HbA1c test during the year 80%

Ideal target 100%

Did you know there is an audit related to this topic? See "Laboratory testing in diabetes in primary care", bpacnz (2011).

Notes:
Time period: 1 October 2009 to 30 September 2010.
Data is assigned to you based on the recorded NZMC number for prescriptions written for diabetes medications or self-monitoring testing strips for patients aged 20 years or over. Data has been excluded where the NZMC number or the encrypted NHI was not recorded. You may not have ordered the laboratory tests.
Patients with diet controlled diabetes who do not self-monitor, will not appear in this report.
Females between the age of 12 and 45 prescribed metformin only have been excluded from the analysis due to the possibility that they may be on metformin for polycystic ovary syndrome.