NICE guidelines & HbA1c testing

[Member496333]

...and what’s absolutely priceless is that I get told off for self testing.

This is the bit that creases me up. HbA1c I can take it or leave it, but the ridicule for self testing actually angers me and is nothing short of dangerous, and even life threatening.

 

[Listlad]

It’s not just me having this issue then !!

It remains to be seen how it goes. He might have a memory lapse or change his mind. I am hoping he will say, “tell ‘em at the desk that he said so” or similar to that effect.

Unfortunately it does seem that one has to chase them as it doesn’t happen so much the other way around.

 

[Listlad]

I was at the surgery for other blood tests & asked nurse if she would do HbA1c as well, she said no because of the NICE guidelines stating yearly so I have to wait until next January and what’s absolutely priceless is that I get told off for self testing.

Well, if the doc goes back on his word I will use that in my response.

 

[Atad heavy]

My husband has the right attitude with our surgery, he had blood tests taken for a problem he had and here is the telephone conversation he had with the Dr when the results were back :-
Dr. Mr —— your cholesterol is a bit high, how do you feel about taking statins?
Husband - No
Dr - your HbA1c is in the pre-diabetic range, I see we have been monitoring it for the last 8 years. I would like you to see the diabetic nurse
Husband - No, you haven’t been monitoring my blood because this is the first blood test I have had in 8 years
Is it all about the extra money that they are paid?

 

[Listlad]

Is it all about the extra money that they are paid?

You might be right there Tad. My GP offered them to me about 18 months ago. Fortunately my cholesterol is in better shape now since altering my diet strategy.

 

[Oldvatr]

Wow, there appears to be a lot of discrepancy between surgeries.

It is a postcode lottery, and does depend very much on the CCG that funds the GP surgery you use. They are bean counters and they have local power to make their own decisions on testing and monitoring.

I am lucky in that I am on a med that can cause hypo's, and my GP is able to interpret the fact that I reported having some, as a way to support some SMBG essentials, such as strips for my meter. I rewarded him by using the SMBG to bring my diabetes into control and to reduce the level of medication needed, He has supported me for 4 yeats now, and this year I was actually declared to be in clinical remission on my diabetes, and was off all diabetes meds. However, since then I have had a major heart operation, and my bgl control went out the window and I am slowly getting it back into control again

I too was on annual HBA1c reviews, but my recent troubles has put me back on 3 monthly while I struggle to get things back to where they should be. Just yesterday I had a full day of readings that all began 5.<n> mmol.l but this morning my fasting bgl was back up at 9, so I am still getting liver dumps from the hospital food,

 

[Ashintheuk]

It is a postcode lottery, and does depend very much on the CCG that funds the GP surgery you use. They are bean counters and they have local power to make their own decisions on testing and monitoring.

I am lucky in that I am on a med that can cause hypo's, and my GP is able to interpret the fact that I reported having some, as a way to support some SMBG essentials, such as strips for my meter. I rewarded him by using the SMBG to bring my diabetes into control and to reduce the level of medication needed, He has supported me for 4 yeats now, and this year I was actually declared to be in clinical remission on my diabetes, and was off all diabetes meds. However, since then I have had a major heart operation, and my bgl control went out the window and I am slowly getting it back into control again

I too was on annual HBA1c reviews, but my recent troubles has put me back on 3 monthly while I struggle to get things back to where they should be. Just yesterday I had a full day of readings that all began 5.<n> mmol.l but this morning my fasting bgl was back up at 9, so I am still getting liver dumps from the hospital food,

When you go onto insulin, you have to test within 2 hours of starting your journey, and stop every 2 hours to test. Remembering to test every morning and every afternoon at the end of the working day is a bind. You also have to test twice a day irrespective of whether you are driving to retain your driving licence according to dvla. I'm going through the strips like crazy to keep up with the requirements

 

[Oldvatr]

When you go onto insulin, you have to test within 2 hours of starting your journey, and stop every 2 hours to test. Remembering to test every morning and every afternoon at the end of the working day is a bind. You also have to test twice a day irrespective of whether you are driving to retain your driving licence according to dvla. I'm going through the strips like crazy to keep up with the requirements

I note that the OP is controlling T2D by diet only at the moment.

I am not sure that the the DVLA mandates testing even if not driving, although an insulin user will probably do this anyway.

 

[Ashintheuk]

I note that the OP is controlling T2D by diet only at the moment.

I am not sure that the the DVLA mandates testing even if not driving, although an insulin user will probably do this anyway.

I read it here. https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving/driving-licence

 

[Rachox]

Can we please keep this thread on track, we are discussing frequency of HbA1cs not DVLA requirements for finger pricks. As @Oldvatr has pointed out the OP does not take insulin so it’s irrelevant anyway.

 

[Ashintheuk]

Can we please keep this thread on track, we are discussing frequency of HbA1cs not DVLA requirements for finger pricks. As @Oldvatr has pointed out the OP does not take insulin so it’s irrelevant anyway.

Ok, if your controlling your hba1c with diet alone, and the numbers are still below 50, then they won't favour testing more than once a year. You aren't in a place where they will want to keep that close an eye on you

 

[Rachox]

Ok, if your controlling your hba1c with diet alone, and the numbers are still below 50, then they won't favour testing more than once a year. You aren't in a place where they will want to keep that close an eye on you

My HbA1cs have been well below 50 for around two years and I still receive the NICE recommended testing frequency of six monthly. It would appear that people on this thread aren’t receiving the care they are entitled to.

 

[TriciaWs]

I was diagnosed a year ago, got my BS and HbA1c down into the normal range by the three month test and am now on six monthly. I would strongly resist annual testing or being reassigned as 'no longer diabetic' as I need support to counter my ongoing food cravings and eating history.

 

[Rachox]

Posts have been deleted for continued derailment discussing DVLA regulations for finger pricking. This thread is about frequency of HbA1c test. Please keep on topic. Thanks.

 

[Bluetit1802]

I am diet only and have had HbA1cs under the T2 cut off for the past 5 years. I am a stable Mabel with no other health issues of note. I still have 6 monthly tests even though my GP has coded me as diabetes resolved. I get the full range of tests each time (HbA1c, cholesterol, full lipid panel, full blood count, kidney and liver functions, EGFR and Gamma GT, all of which are in the normal range). What I do not get are 6 monthly nurse reviews. I just see her once a year (which suits me fine).
A few years ago my nurse said she was moving me to annual tests, but that never happened.

 

[Pipp]

I have seen changes in frequency of HbA1c testing in the fourteen years since I was diagnosed T2. They were every 3 months at the start. I also was given a free meter, and unlimited prescribed test strips.

Since, by my own efforts 8 years ago, I achieved non-diabetic BG levels that has tailed off. The prescibed test strips stopped at the same time as my good control. The 3 monthly recalls for HbA1c continued a while longer. About 5 years ago that moved to six monthly. Two years ago, nurse suggested annually. I asked and was given 6 monthly. Last year or so, no recall from surgery. I had to ask for blood form, and was told by admin that I would only be given one if I attended to have foot check, and BP monitoring as that is on the database, and the surgery gets paid for ensuring patients with diabetes are monitored annually. If a percentage ( not sure how much) of patients with diabetes is not seen it affects surgery income.

 

[Oldvatr]

I have seen changes in frequency of HbA1c testing in the fourteen years since I was diagnosed T2. They were every 3 months at the start. I also was given a free meter, and unlimited prescribed test strips.

Since, by my own efforts 8 years ago, I achieved non-diabetic BG levels that has tailed off. The prescibed test strips stopped at the same time as my good control. The 3 monthly recalls for HbA1c continued a while longer. About 5 years ago that moved to six monthly. Two years ago, nurse suggested annually. I asked and was given 6 monthly. Last year or so, no recall from surgery. I had to ask for blood form, and was told by admin that I would only be given one if I attended to have foot check, and BP monitoring as that is on the database, and the surgery gets paid for ensuring patients with diabetes are monitored annually. If a percentage ( not sure how much) of patients with diabetes is not seen it affects surgery income.

Spot on about surgery income being tied to annual checkup. Also about that checkup having certain tickboxes to meet, There is also a minimum set of blood checks, but these are limited to things like TC and no blood composition checks like RBC, eGFR, lipid panel etc. Those are ones the GP must request for medical reasons, and not part of normal diabetes screening.

It is to do with the NICE national rollout of monitoring GP performance levels by sweeping everybody's health records into the national database which all GP practices are now being subscribed into, You can elect to drop out of this but you have to apply to the relevant authority, and there is a small leaflet pinned to the PALS noticeboard in our practice about this. I only read it because I am nerdy like that. I think it is like the changes about organ donation where you have to actively request NO if you want to keep everything where it should be. Otherwise you are automatically enrolled.

 

[Daphne917]

Ok, if your controlling your hba1c with diet alone, and the numbers are still below 50, then they won't favour testing more than once a year. You aren't in a place where they will want to keep that close an eye on you

I have mine tested every 6 months and my hba1c has been in the non diabetic range for approx 5 years.

 

[Mr_Pot]

Maybe some of the variation in the frequency of testing is because there are posts on this thread from Type 1's, Type 2's, Type 2's on insulin, LADA and Pre-diabetics.

 

[lucylocket61]

I do not get notified by my surgery about having a blood test or checks. I have to be pro-active. However, I make appointments every 6 months, and they are happy to go alone with it.