HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.
HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.
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DOI：
10.1136/bmj.h6138
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发表时间：
2015-12-08
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影响因子：
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通讯作者：
Shah ND
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作者：
McCoy RG;Van Houten HK;Ross JS;Montori VM;Shah ND
研究问题：在控制的2型糖尿病患者中，过度检测糖化血红蛋白（HbA 1c）的程度和影响是什么？方法回顾性分析2001- 2013年美国商业保险个人的国家行政索赔数据库的数据。研究患者年龄在18岁或以上，患有2型糖尿病，血糖控制稳定（24个月内连续两次检测显示HbA 1c <7.0%），未使用胰岛素，无严重低血糖或高血糖病史，未怀孕。在第二次（索引）HbA 1c检测后24个月内测量HbA 1c检测频率，并分类为指南推荐（≤2次/年）、频繁（3-4次/年）和过度（≥5次/年）。治疗方案的变化在指数测试的三个月内确定。 研究答案和局限性在研究队列的31545例患者中（平均年龄58岁;平均HbA 1c指数6.2%），6%的患者HbA 1c检测频率过高，55%的患者频繁检测。尽管基线血糖控制良好，但8.4%的患者通过添加降糖药物或胰岛素进一步强化治疗（分别占过度、频繁和按照指南测试的患者的13%、9%和7%; P<0.001）。与指南推荐的检测相比，过度检测与治疗强化相关（比值比1.35（95%置信区间1.22至1.50））。过度检测率在2001-08年保持不变，但在2009年后大幅下降。2011年过度检测的几率比2001-02年低46%。研究人群并不代表所有美国2型糖尿病患者，因为其仅限于未接受胰岛素治疗的糖尿病稳定和控制的商业保险成年人。该研究设计未反映HbA 1c检测的使用不足。这项研究补充说，在这个美国稳定和控制的2型糖尿病成年人队列中，超过60%的人接受了过多的HbA 1c检测，这与潜在的过度降糖药物治疗有关。过度的测试导致医疗保健中的浪费问题日益严重，并增加了糖尿病管理中的患者负担。NDS和RGM分别由医疗保健研究和质量机构（R18 HS 18339）和AcademyHealth Delivery System Science Fellowship（2013）提供部分资金。没有宣布竞争利益。其他数据可从麦考伊. rozalina@mayo.edu获得。
Study question What is the extent and effect of excessive testing for glycated hemoglobin (HbA1c) among adults with controlled type 2 diabetes? Methods A retrospective analysis of data from a national administrative claims database included commercially insured individuals in the USA, 2001-13. Study patients were aged 18 years or older, had type 2 diabetes with stable glycemic control (two consecutive tests showing HbA1c<7.0% within 24 months), did not use insulin, had no history of severe hypoglycemia or hyperglycemia, and were not pregnant. HbA1c testing frequency was measured within 24 months after the second (index) HbA1c test, and classified as guideline recommended (≤2 times/year), frequent (3-4 times/year), and excessive (≥5 times/year). Changes in treatment regimen were ascertained within three months of the index test. Study answer and limitations Of 31 545 patients in the study cohort (mean age 58 years; mean index HbA1c 6.2%), HbA1c testing frequency was excessive in 6% and frequent in 55%. Despite good glycemic control at baseline, treatment was further intensified by addition of glucose lowering drugs or insulin in 8.4% of patients (comprising 13%, 9%, and 7% of those tested excessively, frequently, and per guidelines, respectively; P<0.001). Compared with guideline recommended testing, excessive testing was associated with treatment intensification (odds ratio 1.35 (95% confidence interval 1.22 to 1.50)). Excessive testing rates remained unchanged in 2001-08, but fell significantly after 2009. The odds of excessive testing was 46% lower in 2011 than in 2001-02. The study population is not representative of all US patients with type 2 diabetes because it was restricted to commercially insured adults with stable and controlled diabetes not receiving insulin treatment. The study design did not capture the underuse of HbA1c testing. What this study adds In this US cohort of adults with stable and controlled type 2 diabetes, more than 60% received too many HbA1c tests, a practice associated with potential overtreatment with hypoglycemic drugs. Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management. Funding, competing interests, data sharing NDS and RGM are funded partly by the Agency for Healthcare Research and Quality (R18HS18339) and AcademyHealth Delivery System Science Fellowship (2013), respectively. No competing interests declared. Additional data are available from mccoy.rozalina@mayo.edu.