Standards 90% of patients should have had the appropriate blood tests taken (i.e. FBG)

1. Impaired Fasting Glycaemia in General Practice Ciara Carpenter, Michael Twomey Halton and St Helens PCT REAUDIT OBJECTIVES • Reaudit took place 2 months following intervention with same methods. • Results • Now, 73 (95%) had had FBG in the past 12 months • Conclusions • Post-Intervention, standards were met; 95% of patients had the test. • Identifying IFG will become more important as the prevalence of type 2 diabetes continues to rise, as it identifies patients to be targeted for health promotion strategies. • Although the current guidance is to organise GTTs for all patients, the evidence for GTT as a diagnostic test for diabetes is not robust. It is also costly and not convenient for patients. There is increasing evidence for the use of HbA1c in diagnosis of diabetes as it is more sensitive and specific, but also convenient for patients and cheaper to undertake. • Suggested guidelines for GPs; • All patients currently who are identified with IFG should have an OGTT. • If it is thought to be deemed unnecessary, HbA1c could be used to decide which patients are higher risk. These patients could then have an OGTT. • It is likely in the next few years that GTT will be used less and HbA1c will be phased in as a diagnostic tool. Until this happens HbA1c should be used with caution as it has not been formally recommended for this use yet. • Identify whether all patients in the practice population diagnosed with IFG have had a repeat fasting blood glucose (FBG) within the past 12months • Formulate guidelines for GPs from the current evidence surrounding IFG/IGT Standards • 90% of patients should have had the appropriate blood tests taken (i.e. FBG) This standard was set from Joint British Society guidance that all patients with IFG should have annual glucose follow up. RESULTS • Demographics • Age range was 45-88yrs • Mean age 67yrs • 38 were male, 39 female BACKGROUND • Impaired Fasting Glucose (IFG) = plasma fasting glucose between 6.1-6.9mmol/l.  • Impaired Glucose Tolerance = IFG + oral glucose tolerance test (OGTT) values of ≥ 7.8mmol/l and <11.1 mmol/l. • Prevalence in the UK of approximately 17% for the age group 35-65.  • Associated with a dramatically increased risk for Type 2 diabetes; 20-50% of patients with IGT going on to develop the disease within 10 years of diagnosis.  • Increasing evidence to suggest early detection and intervention in these patients will significantly reduce the progression to Type 2 diabetes. • Current guidance (British Diabetic Society& Joint British Society) suggests that all patients with IFG should have an OGTT CONCLUSIONS Standards were not met. Recommendations; I sent out letters to all those patients who had not had the blood test inviting them to attend for the blood test, stressing that it must be a fasting sample (as some of the RBGs taken were probably supposed to be fasting but the patient forgot) and the importance of having the test. METHODOLOGY REFERENCES Audit conducted at Rainford health centre Dec- March 2010. Practice population was searched for patients with IFG, exclusion criteria was those that had gone on to develop diabetes. This produced a sample size of 77 patients. • DiabetesUK website, 2010 • PatientUK website, 2010 • ‘Screening for type 2 diabetes: Literature review and economic modelling’ Health technology assessment 2007