Exclusive: Test change doubles diabetes workloads

GPs face having to treat twice as many patients for diabetes under the health checks programme as originally planned, as the DoH considers basing diagnosis on the more accurate HbA1c test.

But patients who have already received a health check will not be retested, in a move that could intensify inequalities across England.

The majority of PCTs across the country have now begun rolling out the checks, with some offering them from as early as January this year.

Currently, these PCTs are following guidance which states that ‘a fasting plasma glucose (FPG) test is recognised as an acceptable first test to identify those with potential diabetes or at high risk’.

Studies have, however, shown that introducing HbA1c testing could help to identify twice as many cases of diabetes as FPG testing. The test is also more accurate at picking up diabetes among South Asians, a population who are six times more likely to develop the condition than Caucasians.

Dr Terry McCormack, former chairman of the Primary Care Cardiovascular Society, said that ‘it was likely’ that the UK would now adopt HbA1c testing.

‘This will cause problems for PCTs, particularly those with high deprivation and ethnic minority populations, that have already begun their health checks and are not using HbA1c testing,’ he warned.

Professor Kamlesh Khunti, an adviser to the DoH health checks programme, said that new patients would be classified with the new test, but that GPs would not go back and retest patients who had been diagnosed using the FPG tests.

‘HbA1c is definitely a better test for diabetes as it is a much better marker for cardiovascular outcomes,’ he said. ‘It is also a more convenient test as patients do not have to fast before taking it.’

Diabetes UK confirmed that discussions about changing diagnostic criteria were ongoing, with a decision imminent.

A spokesman for the DoH added that the department was awaiting a decision from the WHO before announcing any change to HbA1c testing.

sanjay.tanday@haymarket.com

  • Read this week’s GP dated 22 May for the full version of this story.

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