Minn. — In a study released online earlier this month in The
BMJ, researchers from Mayo Clinic report a national trend
toward overtesting glycated hemoglobin (HbA1C) levels in adult
patients with Type 2 diabetes.
causes redundancy and waste says the study team, adding
unnecessary costs and time burden for patients and providers.
In addition, excessive testing can result in overtreatment
with hypoglycemic drugs, adding additional cost and potential
diabetes monitoring and treatment protocols are not well
defined by professional societies and regulatory bodies. While
lower thresholds of testing frequencies often are discussed,
the upper boundaries are rarely mentioned. Yet, most agree
that for adult patients who are not using insulin, have stable
glycemic control within the recommended targets and have no
history of severe hypoglycemia or hyperglycemia, checking once
or twice a year should suffice. Yet, in practice, there is a
much higher prevalence of excess testing.
findings are concerning, especially as we focus more on
improving the value of care we deliver to our patients — not
only ensuring maximal benefit, but also being mindful of
waste, patient burden and health care costs," says
Rozalina McCoy, M.D., a Mayo Clinic primary care physician and
endocrinologist, and the study’s lead investigator. "As
providers, we must be ever vigilant to provide the right
testing and treatment to our patients at the right times —
both for their well-being and to ensure the best value in the
health care we provide."
investigators believe this study provides definitive evidence
of such excess testing, examining a national cohort of 31,545
nonpregnant adults with controlled noninsulin-treated Type 2
diabetes. Approximately 55 percent of patients in this cohort
achieved and maintained the recommended less than 7 percent
HbA1C level and were tested three or four times a year. Six
percent were tested five or more times. The patient cohort
examined was derived from the OptumLabs Data Warehouse (OLDW)
using de-identified administrative, pharmacy and laboratory
data from 2001 to 2011.
notes that there are a number of potential reasons for
frequent testing — some of which are failings in the health
reasons for more frequent testing include clinical
uncertainty; misunderstanding of the nature of the test —
that is, not realizing that HbA1C represents a three-month
average of glycemic control; or a desire for diagnostic and
management thoroughness," she says. "Other times, it
may be the result of fragmentation of care (more than one
unconnected provider); the need to fulfill regulatory demands,
such as public reporting of performance metrics; or internal
tracking of performance.
our culture often thinks that more is better," she says
that patients and providers may favor additional testing due
to a desire for comprehensive care.
researchers found that excessive testing increased the odds of
overtreatment with one or more drugs, despite normal HbA1C
levels. They also found that among patients receiving bundled
testing (i.e., cholesterol, creatinine and HbA1C tests in the
same day), rates of overtesting were lower.
colleagues and I recognize we still have work to do,"
says McCoy, "And, we hope that these findings will help
inform decision-making for health care providers and patients
research is a result of the ongoing commitment of Mayo Clinic
to improve health and enhance the way patients experience the
delivery of health care. Through the Mayo Clinic Robert D. and
Patricia E. Kern Center for the Science of Health Care
Delivery and its collaborations across Mayo and around the
world, Mayo’s vision is borne out.
includes data from more than 150 million individuals of all
ages and races, from across all 50 states, and includes
commercially insured and Medicare Advantage enrollees. It is a
resource of OptumLabs, a collaborative research and innovation
center cofounded by Mayo Clinic and Optum in 2013. This large
data source enables the researchers to investigate across a
much broader patient base than previously available to health
science researchers, resulting in more definitive findings.