Improving Diabetes Monitoring in People with Sub-optimally Controlled Diabetes: Implementing a Clinical...

Area of Science:

• Clinical Biochemistry
• Diabetes Mellitus Management
• General Practice Services

Background:

• Glycated haemoglobin (HbA1c) is the standard for assessing glycaemic status in diabetes.
• Optimal use of HbA1c testing is crucial for patient outcomes and complication minimization.
• A clinical laboratory-led service development aimed to improve follow-up for high-risk diabetes patients.

Purpose of the Study:

• To develop and evaluate a clinical laboratory-led service to facilitate targeted follow-up of high-risk patients in general practice.
• To assess the impact of monthly reports identifying patients overdue for HbA1c testing on diabetes management.

Main Methods:

• A service development involved sending monthly reports of high-risk individuals (HbA1c ≥ 58 mmol/mol) overdue for testing from a Clinical Biochemistry Laboratory to 60 general practices (Intervention group).
• A control group of 51 practices did not receive these reports (Non-intervention group).
• Comparisons were made between intervention and non-intervention groups, and pre- vs. post-intervention periods (2017-2023).

Main Results:

• The intervention group showed a significantly larger reduction in the proportion of patients overdue for testing (-20.6% vs. -10.3%, p<0.001).
• Greater improvements were observed in patients with HbA1c > 75 mmol/mol (7.8-fold larger improvement, p<0.001).
• The intervention led to improvements in median HbA1c and reduced the overall proportion of patients with HbA1c ≥ 58 mmol/mol, despite increased testing frequency.

Conclusions:

• Clinical laboratories can effectively support general practices in targeting monitoring for high-risk diabetes patients.
• Succinct reports identifying patients overdue for testing can reduce patient numbers, improve diabetes control, and increase target achievement.
• This service development demonstrates a practical approach to enhancing diabetes care through laboratory-practice collaboration.