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

Abstract

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.