Convergence of HbA1c values towards target in 272 primary care patients following nine years of target-driven care.

Background: We wished to determine the effect of a target-driven incentivised programme on haemoglobin A1c (HbA1c ) values in a UK diabetic population.

Methods: An audit was carried out in 1999-2000, which included an estimation of glycaemic control in a randomly selected diabetic cohort from ten primary care practices in Sutton Coldfield, serving a population of 90 000 patients. Each practice was given a randomised list of patients and asked to complete detailed questionnaires on patients with confirmed diabetes. We collected data on 516 patients, 425 of whom had their HbA1c measured in 1999-2000 (Audit 2000). A re-audit of HbA1c was carried out in 2007-08 (Audit 2008) determining the changes in HbA1c since the original audit. Of the original cohort, 272 patients had an audit of HbA1c carried out in Audit 2008.

Results: Overall, a small increase in median and mean HbA1c values was observed. We estimated that the proportion of patients with HbA1c achieving the lower Quality and Outcomes Framework HbA1c target of < 7.5%; 173 of the 272 patients met this target in Audit 2000, whereas the number was 162 in Audit 2008. To understand the changes observed, patients were stratified as quintiles based on the HbA1c in Audit 2000 and changes in HbA1c after 8 years for each quintile were estimated. The mean changes for the different quintiles are: quintile 1 (HbA1c < 6.1%), +1.49%; quintile 2 (HbA1c 6.1- 6.6%), +0.8%; quintile 3 (HbA1c 6.7-7.3%), +0.3%; quintile 4 (HbA1c 7.4-8.5%), -0.18%; and quintile 5 (HbA1c > 8.5%), -1.55%.

Conclusion: Our results suggest that, eight years on, patients with poor glycaemic control in 2000 saw an overall decrease in HbA1c by 2008, with the reverse seen in patients with good control.