Doctors deliver fresh warning over new QOF diabetes targets
Tighter blood glucose control targets for Type 2 diabetes in the QOF are not evidence-based and may do more harm than good, two doctors are warning.
Under the new target coming into effect from April, GPs will have to lower blood glucose levels in half of their patients with type 2 diabetes to below 7% to earn the same amount that they are paid now for achieving a target of 7.5%.
Dr Richard Lehman, a GP in Oxfordshire, and Professor Harlan Krumholz, professor of medicine at Yale University School of Medicine, call for the change to be scrapped a BMJ editorial, arguing it will result in tens of thousands of extra patients needing to be given additional oral treatment or treated with insulin.
As well as the increased costs of daily glucose monitoring and the insulin itself, the additional patients on insulin will be at increased risk of hypoglycaemia and, if they drive for a living, may lose their jobs, the doctors argue.
Three important trials published during the past year have shown that intensive blood glucose control in patients with long standing type 2 diabetes does not provide substantial benefit and may increase the risk of adverse outcomes.
In the wake of the these studies, it was "time to challenge conventional wisdom.", the doctors argued.
'We need better evidence to evaluate the balance of risk and benefit for individual patients, and we need to move away from the simplistic idea that the value of a particular drug or strategy can be predicted by its glycaemic lowering effects.' they write.
In a recent Pulse debate, Dr Martin Hadley-Brown is chair of the Primary Care Diabetes Society and a GP in Thetford, Norfolk, argued the new 7% target was unlikely to be generally achievable, but that practice would put great effort into trying to do so as it is worth 17 points.
He said: 'The evidence that intensive blood glucose control is generally achievable is lacking, and there are even doubts over the safety of nonspecialist practices attempting to impose such tight levels of glycaemic control on a real-world population.'
But co-author of the evidence report for the new indicators, Dr Jonathan Graffy, senior clinical research associate at the University of Cambridge and a GP in Waterbeach, Cambridgeshire, said 45% of type 2 diabetes patients already had an HBA1c reading below 7% and the new targets were more relevant.Doctors have warned that lower HBA1C targets in the QOF will push more patients onto insulin