Superfluous HbA1c testing occuring in the majority of controlled diabetics

1. Greater than 60% of commercially insured patients with initial HbA1c levels <7% were tested more frequently than guideline recommendations.

2. Patients who were tested more than two times a year were more likely to have more comorbid conditions and to be taking more diabetic medications.

Evidence Rating Level: 2 (Good)

Study Rundown: Monitoring blood glucose and HbA1c levels of diabetic patients is imperative for monitoring appropriate therapy. However, studies have shown that testing patients too frequently can lead to increased healthcare costs as well as adversely affect patient treatment outcomes. The purpose of this study was to assess both the prevalence of overtesting using HbA1c levels and the relationship between HbA1c testing and treatment level. 31 545 type II diabetic patients in the United States above the age of 18 years of age who were not on insulin therapy were included in this study. Diabetic testing was grouped into patients who had guideline recommended testing (<2 times/year), frequently (3-4 times/year) and excessive testing (>5 times/year). The majority of the patients assessed tested their HbA1C 3-4 times a year. Patients who were tested more than two times a year were found to be on more diabetes medications and have more comorbid conditions. Additionally, patients living in the northeast United States were more likely to be tested excessively as compared to patients that lived in the midwest. Excessive HbA1C testing associated with higher odds of treatment intensification despite good baseline glycemic control.

This study is timely in bringing to light an issue of overtesting in a time of rising healthcare costs. The study did find however that frequent and excessive testing has been on the decline between 2009 and 2011, the last year of study follow-up. While it provides substantial evidence for the existence of overtesting, it is limited by the study population being confined to only commercially insured patients and lack of data relating to patient outcomes.

Click to read the study in BMJ

Click to read an accompanying editorial in BMJ

Relevant reading: Monitoring glycemic control

In-Depth [retrospective cohort]: The purpose of this study was to assess the relationship between frequency of blood HbA1C testing and treatment intensification. Data was extracted from the Optum Labs Data Warehouse which hosts data from commercially insured and Medicare Advantage patients . 31 454 type II diabetic patients who were not on insulin therapy and had two consecutive HbA1cs <7.0% between 2001-2011 were included in this study. 54.8% of patients assessed had their HbA1c tested 3-4 times a year. Patients who were tested more than 5 times (5.8%) per year were more likely to have their treatment intensified (CI95%1.22 to 1.50). White patients (5.7% and Asian patients (5.8%) were more likely to undergo excessive testing compared to black (4.9%) and Hispanic (5.4%) patients (P <0.001). The prevalence of excessive testing also varied by region with 8.9% in the northeast as compared to 4.0% in the midwest.

Image: PD

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