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QOF's 7% HbA1c target set to rise after safety concerns

By Lilian Anekwe

Exclusive: NICE is set to revise the QOF indicators for type 2 diabetes in light of growing evidence that HbA1c targets below 7.5% could be harmful, Pulse can reveal.

The institute is ready to act after receiving stakeholder statements calling for the 7% target to be amended in light of study data linking intensive blood glucose control to hypoglycaemia and increased mortality.

Pulse revealed in February that NICE was to review the DM23 indicator after a study in The Lancet concluded tight blood glucose control might be ‘dangerous', while the National Prescribing Centre earlier this month suggested the 7% target should be modified.

The institute's QOF indicator advisory committee has now considered two potential changes to the 7% indicator – moving it back up to 7.5%, or retaining it but lowering indicator thresholds to encourage GPs to treat patients less aggressively.

An expert diabetes group suggested lowering the DM23 achievement threshold from the current 40-50% to 30-45%.

But it is understood an increase of the target itself is the committee's favoured option, because of concerns that simply modifying thresholds would reduce the numbers on intensive control too slowly.

Dr Colin Hunter, chair of the QOF indicator advisory committee and a GP in Aberdeen, told Pulse: ‘We received a report from a group of diabetes experts reviewing the evidence and looking at changing the HbA1c target, or changing the thresholds, which is what they suggested.

‘The problem is GPs are quite close to the threshold so lowering them probably won't do a great deal. People aren't going to just take their foot off the accelerator on HbA1c. What we are discussing is avoiding the risk to patients with lower HbA1c levels.'

Dr Richard Lehman, a GP in Banbury, Oxfordshire, and member of the Primary Care Cardiovascular Society, said: ‘I definitely think NICE should move the target upwards. The 7% target has never been defensible in my view, certainly not in the face of recent studies.'

But Dr Martin Hadley-Brown, chair of the Primary Care Diabetes Society and a GP in Thetford, Norfolk, said raising the threshold ‘risked sending the wrong message'.

‘In the early stages of the disease we need to aggressive, but evidence suggests that could be dangerous in people with long-standing disease and particularly the elderly. Keeping 7% but making the thresholds more realistic might be best.'

Dr Colin Hunter Pulse CPD

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