Owen J Driskell1, David Holland2, Jenna L Waldron3, Clare Ford3, Jonathan J Scargill4, Adrian Heald5, Martin Tran6, Fahmy W Hanna7, Peter W Jones8, R John Pemberton9, Anthony A Fryer10. 1. Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, Staffordshire, U.K. 2. National Pathology Benchmarking Service, Department of Medicines Management, Keele University, Staffordshire, U.K. 3. Department of Clinical Biochemistry, Royal Wolverhampton National Health Service Trust, Wolverhampton, U.K. 4. Department of Clinical Biochemistry, Salford Royal Hospital National Health Service Foundation Trust, U.K. 5. Department of Clinical Biochemistry, Salford Royal Hospital National Health Service Foundation Trust, U.K. School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, U.K. 6. Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. 7. Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. Department of Diabetes and Endocrinology, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. 8. Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, Staffordshire, U.K. School of Computing and Mathematics, Keele University, Keele, Staffordshire, U.K. 9. Diabetes UK, North Staffordshire Branch, Newcastle-under-Lyme, Staffordshire, U.K. 10. Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, Staffordshire, U.K. anthony.fryer@uhns.nsh.uk.
Abstract
OBJECTIVE: We previously showed that in patients with diabetes mellitus, glycated hemoglobin (HbA1c) monitoring outside international guidance on testing frequency is widespread. Here we examined the relationship between testing frequency and diabetes control to test the hypothesis that retest interval is linked to change in HbA1c level. RESEARCH DESIGN AND METHODS: We examined repeat HbA1c tests (400,497 tests in 79,409 patients, 2008-2011) processed by three U.K. clinical laboratories. We examined the relationship between retest interval and 1) percentage change in HbA1c and 2) proportion of cases showing a significant HbA1c rise. The effect of demographics factors on these findings was also explored. RESULTS: Our data showed that the optimal testing frequency required to maximize the downward trajectory in HbA1c was four times per year, particularly in those with an initial HbA1c of ≥7% (≥53 mmol/mol), supporting international guidance. Testing 3-monthly was associated with a 3.8% reduction in HbA1c compared with a 1.5% increase observed with annual testing; testing more frequently provided no additional benefit. Compared with annual monitoring, 3-monthly testing was associated with a halving of the proportion showing a significant rise in HbA1c (7-10 vs. 15-20%). CONCLUSIONS: These findings provide, in a large, multicenter data set, objective evidence that testing outside guidance on HbA1c monitoring frequency is associated with a significant detrimental effect on diabetes control. To achieve the optimum downward trajectory in HbA1c, monitoring frequency should be quarterly, particularly in cases with suboptimal HbA1c. While this impact appears small, optimizing monitoring frequency across the diabetes population may have major implications for diabetes control and comorbidity risk.
OBJECTIVE: We previously showed that in patients with diabetes mellitus, glycated hemoglobin (HbA1c) monitoring outside international guidance on testing frequency is widespread. Here we examined the relationship between testing frequency and diabetes control to test the hypothesis that retest interval is linked to change in HbA1c level. RESEARCH DESIGN AND METHODS: We examined repeat HbA1c tests (400,497 tests in 79,409 patients, 2008-2011) processed by three U.K. clinical laboratories. We examined the relationship between retest interval and 1) percentage change in HbA1c and 2) proportion of cases showing a significant HbA1c rise. The effect of demographics factors on these findings was also explored. RESULTS: Our data showed that the optimal testing frequency required to maximize the downward trajectory in HbA1c was four times per year, particularly in those with an initial HbA1c of ≥7% (≥53 mmol/mol), supporting international guidance. Testing 3-monthly was associated with a 3.8% reduction in HbA1c compared with a 1.5% increase observed with annual testing; testing more frequently provided no additional benefit. Compared with annual monitoring, 3-monthly testing was associated with a halving of the proportion showing a significant rise in HbA1c (7-10 vs. 15-20%). CONCLUSIONS: These findings provide, in a large, multicenter data set, objective evidence that testing outside guidance on HbA1c monitoring frequency is associated with a significant detrimental effect on diabetes control. To achieve the optimum downward trajectory in HbA1c, monitoring frequency should be quarterly, particularly in cases with suboptimal HbA1c. While this impact appears small, optimizing monitoring frequency across the diabetes population may have major implications for diabetes control and comorbidity risk.
Authors: Katherine A Sauder; Jeanette M Stafford; Shelley Ehrlich; Jean M Lawrence; Angela D Liese; Santica Marcovina; Amy K Mottl; Catherine Pihoker; Sharon Saydah; Amy S Shah; Ralph B D'Agostino; Dana Dabelea Journal: Diabetes Care Date: 2021-08-10 Impact factor: 17.152
Authors: Jennifer Lewey; Wenhui Wei; Julie C Lauffenburger; Sagar Makanji; Alan Chant; Jeff DiGeronimo; Gina Nanchanatt; Saira Jan; Niteesh K Choudhry Journal: BMJ Open Date: 2017-10-30 Impact factor: 2.692
Authors: Juan J Gagliardino; Petar K Atanasov; Juliana C N Chan; Jean C Mbanya; Marina V Shestakova; Prisca Leguet-Dinville; Lieven Annemans Journal: BMJ Open Diabetes Res Care Date: 2017-01-17
Authors: Adrian H Heald; David Holland; Michael Stedman; Mark Davies; Chris J Duff; Ceri Parfitt; Lewis Green; Jonathan Scargill; David Taylor; Anthony A Fryer Journal: BJPsych Open Date: 2021-12-17