Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines?

Christine Louise Paul, Leon Piterman, Jonathan E. Shaw, Catherine Kirby, Daniel Barker, Jennifer Robinson, Kristy L. Forshaw, Kenneth A. Sikaris, Alessandra Bisquera, Robert W. Sanson-Fisher

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing. Design and Setting: Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months. Participants: Of 13 105 individuals who had either a single HbA1c result ≥7.0% (53 mmol mol−1); or two or more HbA1c tests within the study period. Main outcome measures: Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations. Results: About 58.3% of patients did not have the recommended 6-monthly HbA1c tests and 30.6% did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95% CI = 7.5–13.5) rather than 6 months for HbA1c testing; and 15.7 (95% CI = 13.3–18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77% of patients failed to receive a follow-up HbA1c test and 86.5% failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001). Conclusions: Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.

Original languageEnglish
Pages (from-to)371-377
Number of pages7
JournalAustralian Journal of Rural Health
Volume24
Issue number6
DOIs
Publication statusPublished - 1 Dec 2016

Keywords

  • diabetes mellitus
  • HbA1c
  • patient care management
  • rural health
  • vulnerable populations

Cite this

Paul, Christine Louise ; Piterman, Leon ; Shaw, Jonathan E. ; Kirby, Catherine ; Barker, Daniel ; Robinson, Jennifer ; Forshaw, Kristy L. ; Sikaris, Kenneth A. ; Bisquera, Alessandra ; Sanson-Fisher, Robert W. / Patterns of type 2 diabetes monitoring in rural towns : How does frequency of HbA1c and lipid testing compare with existing guidelines?. In: Australian Journal of Rural Health. 2016 ; Vol. 24, No. 6. pp. 371-377.
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abstract = "Objective: To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing. Design and Setting: Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months. Participants: Of 13 105 individuals who had either a single HbA1c result ≥7.0{\%} (53 mmol mol−1); or two or more HbA1c tests within the study period. Main outcome measures: Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations. Results: About 58.3{\%} of patients did not have the recommended 6-monthly HbA1c tests and 30.6{\%} did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95{\%} CI = 7.5–13.5) rather than 6 months for HbA1c testing; and 15.7 (95{\%} CI = 13.3–18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77{\%} of patients failed to receive a follow-up HbA1c test and 86.5{\%} failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001). Conclusions: Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.",
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Patterns of type 2 diabetes monitoring in rural towns : How does frequency of HbA1c and lipid testing compare with existing guidelines? / Paul, Christine Louise; Piterman, Leon; Shaw, Jonathan E.; Kirby, Catherine; Barker, Daniel; Robinson, Jennifer; Forshaw, Kristy L.; Sikaris, Kenneth A.; Bisquera, Alessandra; Sanson-Fisher, Robert W.

In: Australian Journal of Rural Health, Vol. 24, No. 6, 01.12.2016, p. 371-377.

Research output: Contribution to journalArticleResearchpeer-review

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AB - Objective: To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing. Design and Setting: Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months. Participants: Of 13 105 individuals who had either a single HbA1c result ≥7.0% (53 mmol mol−1); or two or more HbA1c tests within the study period. Main outcome measures: Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations. Results: About 58.3% of patients did not have the recommended 6-monthly HbA1c tests and 30.6% did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95% CI = 7.5–13.5) rather than 6 months for HbA1c testing; and 15.7 (95% CI = 13.3–18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77% of patients failed to receive a follow-up HbA1c test and 86.5% failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001). Conclusions: Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.

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