Diabetes target is a 'threat to patient safety'

New QOF diabetes targets are posing a threat to patients and need to be reassessed, according to NHS Alliance GMS lead Dr David Jenner.

At the Alliance's spring conference in London last week, Dr Jenner challenged DoH director of primary care Dr David Colin-Thome on the issue.

Asked whether it could be fixed in the current financial year, Dr Colin-Thome said: 'I think the answer is no.'

The 2009/10 QOF reduced the lowest HbA1c target for patients with type-2 diabetes from 7.5 per cent to 7 per cent.

Dr Jenner told GP that diabetologists and others believe the new targets pose a risk to patients, since aggressive hypoglycaemic therapy can lead to hidden hypoglycaemia and, in frail elderly people, falls.

He pointed out that the new QOF targets were not in line with current NICE guidance.

'The QOF target is to have 50 per cent of patients with type-2 diabetes below an HbA1c of 7 per cent,' he said. Such treatment could require the addition of insulin or a dipeptidyl peptidase-IV (DPP-IV) inhibitor to therapy with metformin and sulphonylyureas.

'NICE guidance says you should aim to achieve an HbA1c of 6.5 per cent with metformin and sulphonylyureas and only add insulin or a DPP-IV inhibitor if a patient's HbA1c is over 7.5 per cent,' he said. 'And recent studies have shown the danger of aggressive treatment to lower HbA1c levels, in terms of heart risks.'

Dr Jenner said he wanted to see the QOF re-negotiated in-year to clarify how the target should be approached.

'The guidance doesn't set out which 50 per cent you should get below the target and which you shouldn't,' he said.

Patients deemed unsuitable for aggressive hypoglycaemic therapy should be coded as exceptions, he added.


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