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Complaint reply from NHS

RosB

Active Member
Messages
32
So hubby found out this year that he's been diabetic for 2 years. Dr's didn't tell him! We complained to NHS England and got a reply from our local GPs surgery who effed up. Among it was a statement saying
"Clinicians should aim to involve people in decisions about their individual HbA1c target level with 48-58mmol/mol being the standard target." Hubby's HbA1c was 54.
Thoughts?
 
First thought was how can patients be involved in decisions if they aren't told of their diagnosis?

I wasn't told I had fatty liver for years. If I had known about it back when it was first spotted I may not have become T2.

Dreadful uncaring attitude displayed by your surgery.

That's all I can say. I can't post the rest of my thoughts as the expletives would earn me a ban from the forum.

So sorry you have been treated like this.
 
As a diet controlled type 2, I want my target to be well below 48. What was his HbA1c?
 
Those control figures from the practice seem to be incorrect. this is what NICE say about the levels for home monitoring.
"Target blood sugar levels differ for everyone, but generally speaking:
  • if you monitor yourself at home with a self-testing kit – a normal target is 4 to 7mmol/l before eating and under 8.5 to 9mmol/l 2 hours after a meal
  • if your HbA1c level is tested every few months – a normal HbA1c target is below 48mmol/mol (or 6.5% on the older measurement scale)"
(extracted from :=
https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/
which is the NHS website)

The higher figures the practice gave you may apply to someonr using insulin treatment in an effort to reduce the incidence of hypo's caaused by low blood sugars. My GP thinks like that even though he knows I am on orals.
 
Other people have found that practices have confused HbA1c recommendations for T1s with HbA1c recommendations for T2s. This sounds as if that's happened here too. As I understand it, not being T1 myself, T1s are supposed to run a bit higher to avoid risk of hypo.
 
Dark Horse said:
This resource gives an inssight into factors affecting HbA1c targets for people with type 2 diabetes:- https://www.hey.nhs.uk/wp/wp-content/uploads/2018/05/TYPE-2-DIABETES-HbA1c-TARGETS-v4-March-2018.pdf
Click to expand...
Interesting that as I am old but "functionally independent" my HbA1c of 53 on diagnosis was within target. Maybe I could have continued with a huge bowl of muesli for breakfast, a doorstep sandwich for lunch and a large helping of carbs with dinner. Probably better to stick with my moderately low carb diet and HbA1c of 38 particularly as I lost 3 stone and am now at my ideal weight.
 
Dark Horse said:
This resource gives an inssight into factors affecting HbA1c targets for people with type 2 diabetes:- https://www.hey.nhs.uk/wp/wp-content/uploads/2018/05/TYPE-2-DIABETES-HbA1c-TARGETS-v4-March-2018.pdf
Click to expand...
This is the Hull area website, and not necessarily Nationwide. The general exclusion of elderly patients is indicative of an attitude that we oldies are unable to cope with a tighter control regime possibly due to frailty or dementia. or other cognitive disorder. They are IMO wrong to make the exclusion so black and white, but should allow for inclusion of carer input and general cognitive capability. Also they do not reflect the current status of dietary intervention or use of bariatric surgery that are relatively new tools to use, and which are not in themselves hypopoglycaemic inducing interventions.

I can understand there being a need for a warning or higher control band for insulin or sulfonyl users where hypo events can occur. But that is not what this advice seems to be giving, It is a one size fits all, and I mean ALL.
 
That could be interpreted as the target for elderly AND frail rather than just elderly, perhaps. Also it's described as a 'general target' and the slider on the right suggests that it should be lower for 'highly adherent and motivated patients', those who are diet-controlled and/or those with no existing vascular complications.

You sound like you're doing very well.
 
Tje cynic in me says that as soon as you drop below the 48 level, you are no longer diabetic, and so no longer qualify for free prescriptions, and the doctor has ro remove you from their records as such, and these records are used to set their pay and bonus targets. Just saying that the practice is target based for NHS payments via their CCG.
 
Oldvatr said:
But that is not what this advice seems to be giving, It is a one size fits all, and I mean ALL.
Click to expand...
This diagrammatic representation is supposed to a tool to help in setting individual HbA1c targets rather than relying on blanket one-size-fits-all targets. The 'sliders' on the right-hand side show the factors that should be considered when setting a target.
Oldvatr said:
This is the Hull area website, and not necessarily Nationwide
Click to expand...
You might be interested by the Hounslow equivalent:- https://www.hounslowccg.nhs.uk/media/116554/Individualising-HbA1c-targets.pdf

The paper that both illustrations are based on is here:- https://pubmed.ncbi.nlm.nih.gov/21502652/
 
The QOF guidance for 20212 includes this:-

"The Business Rules include a clinical code for “diabetes in remission”. Successful management of diabetes with lifestyle, medication, pancreatic or islet cell transplant and/or bariatric surgery may result in glucose levels falling below those diagnostic of diabetes. However, these people may still experience the macrovascular and microvascular complications of diabetes and therefore need continued monitoring. Experts from the diabetes classification working group have endorsed the use of this code for people where treatment has normalised hyperglycaemia but still require continued monitoring. Practices should review their patient records and re-code patients previously coded as “diabetes resolved” as “diabetes in remission” if they still require monitoring for the reasons outlined above."
https://www.england.nhs.uk/wp-conte...ity-outcomes-framework-changes-for-21-22-.pdf
 
You are still diabetic and should if anything be marked as in remission. You should not be removed from the diabetes registe (and you’d lose all monitoring). Removing from the register should just before those misdiagnosed in the first place as there is no accepted “cure” for type 2.

If you got free prescriptions in the first place (diet only type 2 don’t) the exemption certificate still lasts the rest of the 5 yrs it was issued for.

I agree a lot is target based but I think this goes beyond even my cynicism as well as official guidance unless it changed in the last few months.
 
HSSS said:
If you got free prescriptions in the first place (diet only type 2 don’t) the exemption certificate still lasts the rest of the 5 yrs it was issued for.
Click to expand...
Also, about 90% of all prescriptions are dispensed free of charge, age being a major factor, so many diabetics would continue to get free prescriptions even if their diabetes was considered resolved.
 
RosB said:
54. They say it was OK cos of his age, 51. But high is high surely?
Click to expand...
Yes indeed, but it has been high-lighted recently that in some situations forcing over-perfectionist targets on frail elderly people who have not long to live and who may even be incapable of understanding why they are suddenly being deprived of their familiar and comforting foods, is just cruel.
 
The dr was referencing; Dubowitz et al (2014) he said

 
Hubby doesn't get free prescriptions. It says elsewhere in their report that it's just for diabetic type 1's and type 2's on medication, Thankfully my hubby has managed to reduce his HbA1c to 47 from 54 in 5 months with diet alone. We know he is in "remission" and will carry on with the keto lifestyle.

 
51 is hardly elderly or frail or on deaths door though

Do you have the name or link to this study. I’ve seen reference to it a couple of times lately.
 
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