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Doubt raised on QOF targets for diabetes

By Richard Staines

Putting diabetes patients on strict glucose control regimes could be almost as dangerous as uncontrolled blood sugar levels, research has shown.

Findings – published in The Lancet today – were based on a study of nearly 50,000 patients from the UK General Practice Research Database with type 2 diabetes.

Researchers then divided patients into deciles based on glycated haemoglobin (HbA1c) levels and found that the level with the lowest risk was among patients whose HbA1c levels were at 7.5%.

However the risk was 52% higher in the lowest decile recorded (6.4%), while in the highest decile (10.6%), mortality risk was 79% higher.

Report author Dr Craig Currie, honorary research fellow at Cardiff University School of Medicine, said the study raised doubts about a trend towards incentivising stricter glucose control regimens in QOF.

Last year, the tightest HbA1c QOF target was lowered from 7.5% to 7%.

Dr Currie said: ‘It certainly raises doubts about the value of putting all patients on extremely tight glucose control.

‘We are going to have to reassess the risks and benefits and maybe move towards individualised targets. If you have a patient who is 70-80 years old there is no point in there is no point in putting them on extremely tight regimes.’

The study sample was also subdivided into two cohorts – 27,965 whose treatment had been intensified from oral monotherapy to combination therapy of metformin plus sulphonylurea and 20,005 who had changed to regimens including insulin.

They found all cause mortality in the insulin group (2,834 deaths) was 49% higher than in the combination group (2,035 deaths).

New study raises doubts over QOF targets for diabetes