Improving Diabetes Monitoring in People with Sub-optimally Controlled Diabetes: Implementing a Clinical Laboratory-Led Quality Improvement Initiative in General Practice.

INTRODUCTION

The appropriate use of glycated haemoglobin (HbA1c), the international standard for assessing overall glycaemic status in diabetes mellitus, is critical to ensuring optimal clinical outcome and minimise complications. We describe a clinical laboratory-led general practice service development to facilitate targeted follow-up in high-risk patients.

METHODS

The service development comprised monthly reports identifying high-risk individuals (HbA1c ≥ 58 mmol/mol) overdue HbA1c testing, sent by the Clinical Biochemistry Laboratory to general practices in the 'Intervention' group (n = 60). A 'Non-intervention' group comprised 51 practices not sent the reports. Comparisons comprised: (i) intervention vs non-intervention groups during two time periods (pre-intervention: 2017-2020; 275,843 tests; 59,206 patients, and post-intervention: 2020-2023; 307,525 tests; 65,449 patients), (ii) pre- versus post-intervention in each group.

RESULTS

The intervention group (vs non-intervention group) showed larger net change in proportion overdue a test (- 20.6% vs - 10.3%, p < 0.001), particularly in the > 75 mmol/mol category (7.8-fold larger improvement, p < 0.001). Improvements were also observed in median time overdue in the 58-75 mmol/mol group (- 14.3 vs - 4.3%; p = 0.027). Improvements were identified in median HbA1c (p = 0.012) and overall proportion with HbA1c ≥ 58 mmol/mol (p = 0.037), compared with the non-intervention group, despite performing more tests/patient/year (p < 0.001). All remained significant after adjustment for practice characteristics (age, sex, social deprivation, list size, diabetes prevalence) and pre-intervention levels.

CONCLUSIONS

Our findings indicate that clinical laboratories can support general practices facilitating targeting monitoring to high-risk patients. Providing succinct reports that identify patients overdue for testing can reduce the number of such patients, thereby improving diabetes control and increasing the achievement of target levels.