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Abstract
BackgroundIn January 2010, the American Diabetes Association recommended the use of hemoglobin A1c (Hgb A1c) to screen and diagnose diabetes. This study explored the prevalence and clinical context of Hgb A1c tests done for non-diabetic primary care patients for the three years prior to the release of the new guidelines. We sought to determine the provision of tests in non-diabetic patients age 19 or over, patients age 45 and over (eligible for routine diabetes screening), the annual change in the rate of this screening test, and the patient characteristics associated with the provision of Hgb A1c screening.MethodsWe conducted a retrospective study using data routinely collected in Electronic Medical Records. The participants were thirteen community-based family physicians in Toronto, Ontario. We calculated the proportion of non diabetic patients who had at least one Hbg A1c done in three years. We used logistic generalized estimating equation with year treated as a continuous variable to test for a non-zero slope in yearly Hbg A1c provision. We modelled screening using multivariable logistic regression.ResultsThere were 11,792 non-diabetic adults. Of these, 1,678 (14.2%; 95%CI 13.6%-14.9%) had at least one Hgb A1c test done; this was higher for patients 45 years of age or older (20.2%; 95% CI 19.3% - 21.2%). The proportion of non-diabetic patients with an A1c test increased from 5.2% in 2007 to 8.8% in 2009 (p < 0.0001 for presence of slope). Factors associated with significantly greater adjusted odds ratios of having the test done included increasing diastolic blood pressure, increasing fasting glucose, increasing body mass index, increasing age, as well as male gender and presence of hypertension, but not smoking status or LDL cholesterol. Patients living in the highest income quintile neighbourhoods had significantly lower odds ratios of having this test done than those in the lowest quintile (p < 0.001).ConclusionsA large and increasing proportion of the non-diabetic patients we studied have had an Hgb A1c for screening prior to guidelines recommending the test for this purpose. Several risk factors for cardiovascular disease or diabetes were associated with the provision of the Hgb A1c. Early uptake of the test may represent appropriate utilization.
Highlights
In January 2010, the American Diabetes Association recommended the use of hemoglobin A1c (Hgb A1c) to screen and diagnose diabetes
The number of active rostered patients age 19 and over was 13,112, and,11,792 patients (89.9%) were not diabetic. Of these non-diabetic patients, 1,678 (14.2%; 95% CI 13.6% - 14.9%) had at least one Hgb A1c test done in the three year period prior to the release of the new American Diabetes Association (ADA) guidelines
The physicians in this study began using the Hgb A1c test for some non-diabetic patients well before the release of the guidelines; we found that a fifth of patients without diabetes age 45 or more had at least one Hgb A1c done in a three year period
Summary
In January 2010, the American Diabetes Association recommended the use of hemoglobin A1c (Hgb A1c) to screen and diagnose diabetes. This study explored the prevalence and clinical context of Hgb A1c tests done for non-diabetic primary care patients for the three years prior to the release of the new guidelines. Diabetes is an increasingly prevalent condition in Canada, with serious effects on morbidity and mortality [1]. This condition can be present for up to seven years prior to diagnosis [2], leading to recommendations for periodic screening of asymptomatic individuals [1,3,4]. The ADA suggested that Hgb A1c be considered as an acceptable test to diagnose diabetes, with a confirmed value of 6.5% or greater being diagnostic [3]
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