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World Diabetes Day 2019 – New measure could give better indication of outcomes

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World Diabetes Day highlights the importance of confronting diabetes as a critical health issue. Efforts to better prevent, manage and treat diabetes are all essential steps in tackling the disease, and a recent study from the Population Health Research Institute at St. George’s has identified how doctors may improve and better monitor the likely outcomes for patients with diabetes.

A research team led by Professor Julia Critchley has found that measuring the fluctuation in levels of a protein, called glycated haemoglobin (or HbA1c), may help to predict patients’ likelihood of death or unplanned hospitalisation.

While typically doctors measure HbA1c levels in diabetes patients on a regular basis, it’s typically only assessed against an individualised patient target to see how well the disease is being managed. These new results suggest that a measure of variability in HbA1c over time may actually be more important.

Using routine data on HbA1c collected in primary care from 58,832 adults with type 2 diabetes between 2006 and 2009, the researchers studied the electronic health records of patients from 2010 to 2015. Their results showed that patients with the least stable levels of HbA1c were almost twice as likely to die as those with the most stable levels. A similar effect was seen when assessing the number of emergency hospitalisations for patients in the same time period.

Professor of Epidemiology at St George’s, Julia Critchley, said:

“At the moment, family doctors tend to have patient targets for specific levels of HbA1c, but not for stability. Our results suggest that measuring stability might give a better idea of which patients are at higher risk and may need referral, or those who may benefit from further advice or increasing medication.”

Professor Critchley’s hope is that it would only take a simple change in the algorithms of doctors’ databases to provide a measure of HbA1c variability in primary care clinics. Doctors could then provide the appropriate advice based on the risks associated with the patient’s results.

Although these results point to a potential change in clinical practice, Professor Critchley acknowledges that these data need to be confirmed in further trials.

“Our study is only based on observational data,” she adds. “Our results need to be tested in randomised clinical trials that promote the stability of HbA1c. If newer medications or lifestyle changes that maintain stable levels of HbA1c are tested, we could see if that improves outcomes in the longer term.”

If this is found to be the case, more could be done to better protect the lives of those living with diabetes around the world.

Published: 14 November 2019

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