Diabetes Patients Frequently Overtested and Overtreated

More than 60% of adults with well-controlled type 2 diabetes not on insulin and without a history of complications receive too many hemoglobin A1c (HbA1c) tests, according to a new study.

“Such excessive testing had additional harms beyond potential waste of patients’ and society’s time and resources,” said lead author Rozalina G. McCoy, MD, of the division of endocrinology, Mayo Clinic. “We found that excessive testing was associated with greater risk of treatment intensification despite the fact that all patients in the study already met glycemic targets by having HbA1c under 7%. Indeed, treatment was intensified by addition of more glucose-lowering drugs or insulin in 8.4% of patients (comprising 13%, 9%, and 7% of those tested 5 or more times per year; 3-4 times per year; and 1-2 times per year, respectively).”
______________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Do HbA1c Levels Help Cardiovascular Risk Assessment
When Should Insulin be Started?
______________________________________________________________________________________________________________________________________________________________________

The researchers conducted a retrospective study of 31,545 adults across the United States with stable and controlled type 2 diabetes who had achieved and maintained HbA1c less than 7% without use of insulin and without a documented history of severe hypoglycemia or hyperglycemia. They found 55% of patients had their HbA1c checked 3-4 times per year and 6% had it tested 5 times a year or more.

“We were able to identify potential causes of overtesting, though because this is a retrospective study, we cannot definitively ascertain causality for these findings,” McCoy said. “Specifically, we found that patients who saw a larger number of doctors on any given year were significantly more likely to be overtested, as were patients living in the northeast U.S. and those receiving care from an endocrinologist—though we could not tell the specialty of providers who actually ordered the extra tests.”

McCoy said primary care providers play a key role in ensuring appropriate treatment for their patients, coordinating care with specialists when needed, and educating patients about the risks and benefits of different testing and treatment interventions.

“It is therefore important for clinicians and patients to engage in informed shared decision making about chronic disease management,” she stressed.

McCoy said she will continue to work to better understand the reasons for overtesting, whether it’s clinical uncertainty, misunderstanding the nature of the HbA1c test, desire for diagnostic or management thoroughness, fragmentation of care, or the need to fulfill regulatory demands, such as reporting of performance metrics.

-Mike Bederka

Reference:

McCoy RG, Van Houten HK, Ross JS, et al. HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study. BMJ. December 8, 2015. [epub ahead of print]. doi: http://dx.doi.org/10.1136/bmj.h6138.