Understanding the relationship between the frequency of HbA1c monitoring, HbA1c changes over time, and the achievement of targets: a retrospective cohort study
Background The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3–6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, p...
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| Vydané v: | BMC endocrine disorders Ročník 25; číslo 1; s. 3 - 11 |
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| Hlavní autori: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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London
BioMed Central
06.01.2025
BioMed Central Ltd Springer Nature B.V BMC |
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| ISSN: | 1472-6823, 1472-6823 |
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| Abstract | Background
The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3–6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort.
Research design and methods
The study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa’s guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c.
Results
The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2–4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence.
Conclusions
The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. |
|---|---|
| AbstractList | Abstract Background The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3–6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort. Research design and methods The study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa’s guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c. Results The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2–4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence. Conclusions The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3-6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort.BACKGROUNDThe goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3-6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort.The study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa's guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c.RESEARCH DESIGN AND METHODSThe study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa's guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c.The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2-4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence.RESULTSThe 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2-4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence.The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time.CONCLUSIONSThe results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. Background The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3-6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort. Research design and methods The study utilised routinely collected HbA1c test data on patients with diabetes aged [greater than or equal to] 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa's guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c. Results The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2-4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence. Conclusions The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. Keywords: Type-2 diabetes, Monitoring, HbA1c, Glycaemic control, Low-and-Middle Income countries BackgroundThe goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3–6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort.Research design and methodsThe study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa’s guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c.ResultsThe 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2–4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence.ConclusionsThe results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. Background The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3–6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort. Research design and methods The study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa’s guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c. Results The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2–4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence. Conclusions The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3-6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort. The study utilised routinely collected HbA1c test data on patients with diabetes aged ≥ 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa's guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c. The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2-4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence. The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3-6 monthly HbA1c monitoring. Despite this guidance, there are few data supporting the impact of monitoring frequency on clinical outcomes, particularly from low- and middle-income country settings. This study evaluates the short-term impact of HbA1c monitoring intervals on changes in HbA1c levels, and the impact of adherence to monitoring recommendations on the achievement of HbA1c targets and HbA1c changes over time in a South African cohort. The study utilised routinely collected HbA1c test data on patients with diabetes aged [greater than or equal to] 18 years in the Western and Northern Cape between 2015 and 2020. Two properties were calculated for each patient: the retest interval (the duration between consecutive HbA1c tests), and the monitoring adherence rate, which represents the proportion of retest intervals that met South Africa's guideline recommendations. Mean changes in HbA1c by the retest interval were used to highlight the short-term impact of monitoring, while multistate modelling and linear mixed-effects modelling were then used to examine the effect of monitoring adherence on the achievement of glycaemic control targets and longitudinal changes in HbA1c. The 132,859 diabetes patients with repeat tests had a median of three HbA1c test requests, a median follow-up time of 2.3 years and a median retest interval of 10.3 months. A retest interval 2-4 months maximised the downward trajectory in HbA1c, while individuals with low adherence to the monitoring guidelines were the least likely to achieve glycaemic control in one year. Moreover, patients with low monitoring adherence had higher mean HbA1c levels compared to patients with moderate or high monitoring adherence. The results from this study illustrate the importance of adherence to monitoring recommendations as adherent patients had better glycaemic control and lower mean HbA1c levels over time. |
| ArticleNumber | 3 |
| Audience | Academic |
| Author | Mukonda, Elton van der Westhuizen, Diederick J. Dave, Joel A. Rusch, Jody A. Cleary, Susan Lesosky, Maia Hannan, Luke |
| Author_xml | – sequence: 1 givenname: Elton surname: Mukonda fullname: Mukonda, Elton email: elton.mukonda@uct.ac.za organization: Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town – sequence: 2 givenname: Diederick J. surname: van der Westhuizen fullname: van der Westhuizen, Diederick J. organization: Division of Chemical Pathology, Department of Pathology, University of Cape Town, National Health Laboratory Service, Groote Schuur Hospital – sequence: 3 givenname: Joel A. surname: Dave fullname: Dave, Joel A. organization: Division of Endocrinology, Department of Medicine, Groote Schuur Hospitaland the, University of Cape Town – sequence: 4 givenname: Susan surname: Cleary fullname: Cleary, Susan organization: Health Economics Unit, School of Public Health, University of Cape Town – sequence: 5 givenname: Luke surname: Hannan fullname: Hannan, Luke organization: Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town – sequence: 6 givenname: Jody A. surname: Rusch fullname: Rusch, Jody A. organization: Division of Chemical Pathology, Department of Pathology, University of Cape Town, National Health Laboratory Service, Groote Schuur Hospital – sequence: 7 givenname: Maia surname: Lesosky fullname: Lesosky, Maia organization: National Heart and Lung Institute, Imperial College London |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39757191$$D View this record in MEDLINE/PubMed |
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The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend... The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend 3-6 monthly... Background The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend... BackgroundThe goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines recommend... Abstract Background The goal of post-diagnosis diabetes management is the achievement and maintenance of glycaemic control. Most clinical practice guidelines... |
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| SubjectTerms | Adults Clinical outcomes Diabetes Diabetes mellitus Diabetics Disease management Endocrinology Glycaemic control Glycosylated hemoglobin HbA1c Laboratories Low income groups Low-and-Middle Income countries Medicine Medicine & Public Health Metabolic Diseases Monitoring Mortality Patient compliance Patients Practice guidelines (Medicine) Primary care Public sector rology Sensitivity analysis Type-2 diabetes Variables |
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| Title | Understanding the relationship between the frequency of HbA1c monitoring, HbA1c changes over time, and the achievement of targets: a retrospective cohort study |
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