By Lilian Anekwe
NICE has raised the QOF HbA1c target in patients with type 2 diabetes up to 7.5% from 7% - conceding that there is sufficient ‘uncertainty' about patient safety to justify the move.
Pulse exclusively revealed in June that the independent NICE QOF indicator advisory committee was considering the change after several studies linked intensive blood glucose control to an increased risk of hypoglycaemia and mortality.
Two options had been considered: either lowering the DM23 threshold from 40-50% down to 30-45%, or raising the HbA1c target to avoid GPs treating patients too aggressively and putting them at risk of harm – with the latter option preferred by the committee.
In minutes from its latest meeting the committee states: ‘In order to achieve a practice target of 7.0%, a clinician may need to aim for an HbA1c below this in individual patients. The committee agree that there was a potential risk of unintended consequences in relation to a subset of people with diabetes.'
‘Reducing thresholds would not be the most appropriate way of mitigating this risk. The committee recommended that the threshold for DM23 should remain unchanged but that the HbA1c target should be increased to 7.5%.'
Dr Richard Lehman, a GP in Banbury, Oxfordshire and member of the primary care cardiovascular society, said the 7% target ‘should never have come into force'.
‘The QOF target has almost certainly caused harm to patients. This is reflected in national audit figures which show a misdirection of effort in trying to reduce HbA1c in well-controlled patients with longstanding disease while ignoring high-risk, poorly compliant patients who will never fall neatly into the QOF system of targets. These are the people we should concentrate our efforts on, whether or not we get paid for doing so.'
In the same review of current QOF indicators the committee also recommended - as Pulse revealed in June - that NICE will amend the AF3 indicator to include a risk assessment, and a new indicator would be developed to encourage GPs to prescribe warfarin, rather than aspirin, to those people identified as at moderate or high risk of stroke.The HbA1c QOF target has been raised to 7.5% The HbA1c QOF target has been raised to 7.5%