Abstract

National evidence-based guidelines recommend that people with diabetes have their HbA1c, blood lipids and albumin:creatinine ratio (ACR) monitored at least annually. However, international literature indicates a quality of care gap between the published clinical recommendations and actual clinical practice. A prospective cohort study was conducted to examine the patterns of laboratory monitoring in people with diabetes by linking patient profile data generated in routine primary care practice in 2 major regions of New Zealand between 2005 and 2012 with national and regional datasets (primary care enrolment, laboratory tests, hospitalizations, mortality and pharmaceuticals).We identified 56,933 people aged ≥35 years with diabetes. People were defined as being monitored according to recommended guidelines if they had ≥1 test a year from entry into the cohort. The proportion monitored yearly varied between 27.5% and 100% (mean=72.7%, SD=24.0%) for HbA1c, 17.1% to 100% (mean=66.0%, SD=27.5%) for blood lipids and 10% to 100% (mean=57.3%, SD=29.0%) for ACR. For most of laboratory monitoring indices, increasing age, body mass index (BMI), race, area deprivation, smoking status and having a previous cardiovascular disease (CVD) event were significantly associated with a higher likelihood of being monitored according to the guidelines. This study revealed that a small proportion of people with diabetes were being consistently monitored according to the recommended guidelines over an 8-year period, with HbA1c being monitored the most. Risk factors for CVD were associated with an increased likelihood of being monitored according to recommended guidelines. Developing more pro-active audit and feedback strategies for appropriate monitoring may support primary care achievement of recommended monitoring goals.

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