medwireNews: Formal recognition of type 2 diabetes remission in primary care may lead to suboptimal health monitoring, a study suggests.
Researchers looked at the receipt of eight key care processes, such as annual checks of glycated hemoglobin (HbA1c), blood pressure, and urinary albumin, and found that just 42.5% of people with a diagnostic code for diabetes remission received all eight of these care processes.
By contrast, 60.8% of people without a remission code received all eight. The largest differences were for urinary albuminuria and foot examinations, with 56.2% versus 70.8% of those with and without a remission code having the former checked, and 64.9% versus 86.0% receiving the latter.
“People in remission from type 2 diabetes are at high risk of returning to diabetic hyperglycaemia and therefore regular HbA1c measurements are imperative to allow appropriate treatment strategies to be implemented at the earliest opportunity,” write the researchers in Diabetic Medicine.
“Other care processes that identify risk factors for, or early signs of, macro and micro vascular disease and other complications of diabetes are also likely to be beneficial and should be encouraged.”
The study data come from the annual National Diabetes Audit for England and Wales. Between January 2018 and March 2019, 0.58% of 2,822,145 people with type 2 diabetes received a diagnosis code for remission.
Naomi Holman (University of Glasgow, UK) and study co-authors note that previous data from the audit showed that age, ethnicity, and deprivation were associated with the likelihood of appropriate receipt of care processes. However, after accounting for these factors, people with a remission code remained a significant 30% less likely to receive all processes than those without.
A considerably larger proportion of the cohort – 12.0% – had evidence of remission in that these people had at least one HbA1c measurement below 48 mmol/mol (6.5%) that occurred after a period of 26 weeks with no prescription for glucose-lowering medications.
The researchers also found some differences in receipt of care processes between people with evidence of remission and those without, but to a smaller degree than was seen for people with a remission code. Specifically, 57.7% versus 61.1% received all eight care processes, and in fact people with evidence of remission more frequently had HbA1c, blood pressure, and creatinine measured than those without.
The team highlights that 96.4% of people with evidence of diabetes remission had no diagnostic code, stressing that “there is no reliable way to simply identify people who have been diagnosed with type 2 diabetes who subsequently enter remission through healthcare records either to provide on-going care to these individuals or for population level analyses to add to the understanding of characteristics, comorbidities and prognosis.”
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Diabet Med 2022; doi:10.1111/dme.15016