Besides the cost of testing, excessive testing was associated with more medication changes that might not be necessary.
In this era of quality measurement, it’s gospel that patients with type 2 diabetes should have regular glycated hemoglobin (A1C) tests to make sure that medications are working and no changes are needed.
But a study by a group of researchers at the Mayo Clinic, just published in BMJ, throws a wrench in that thinking. It asks whether it might be better for patient health—and for savings to the healthcare system—to test some patients less frequently than at 3-month intervals.
The retrospective analysis looked at 2001-2013 data from a national claims database of patients with commercial insurance. It focused on patients who had 2 consecutive A1C tests of less than 7.0% within 24 months, did not use insulin, had no history of severe hypoglycemia or hyperglycemia and were not pregnant.
Patients’ A1C was measured within 24 months of the second test and classified as “guideline recommended”, which is twice a year; “frequent,” which is 3-4 times a year; or “excessive,” which is 5 or more times a year.
Of the 31,545 patients studied, who had a mean age of 58 years and an average A1C of 6.2%, testing was excessive for 6% and frequent for 55%--which means 60% of the patients likely had more testing than they needed.
So, is this a problem?
In addition to the cost of testing itself, yes, the researchers found. Despite the good glycemic control, a number of the patients (8.4%) saw their medication adjusted. More frequent testing was associated with a greater likelihood of an increase in medication—13% for those tested excessively, 9% for those tested frequently, and 7% for those testing twice a year.
For patients whose diabetes is under control, the authors wrote, too much testing is associated “with potential overtreatment with hypoglycemic drugs. Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management.”
McCoy RG, Van Houten HK, Ross JS, Montori VM, Shah ND. HbA1C overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-2013: observational population based study [published online December 8, 2015. BMJ. 2015; 351:h6138.