NICE guidelines & HbA1c testing

In Scotland we have SIGN guidelines so you find Drs use a combination of both when making decisions but at end of day they are only guidelines not policies so Drs are expected to use a bit of their medical knowledge & common sense when making decisions!!
GP recently upped my medication & told me i should test my BS every morning & that was it.! Had to go source & pay for my own glucometer, strips & lancets as they never even offered me one! I am doing blood sugar diet so asked if i could get support from dietician in the surgery.....i got invite to a healthboard wide open day for newly diagnosed diabetics (ive been T2 for 8years) who need to understand diet...honestly!!! Ive therefore booked myself a private appt with a naturopath.
I work for NHS & have done so for a very long time & i think on the whole its a good service. However, i feel a lot of people with T2 diabetes are being let down by the service & GPs not that interestedx

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lucylocket61 said:

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.

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Same here. I have to be proactive too.

I have a HbA1c every six months (they contact me by letter telling me to make an appointment for the blood taking) but only have a review once a year. This year (and the past few years) the review was with a Health Care Assistant who could only ask the questions on her monitor - when it came to discussing medication (I wanted to reduce Metformin) and other stuff all she kept saying was that I should make an appointment with a doctor. It's been a few years since I had any kind of review with a properly qualified person who is able to do more than tick boxes on a computer screen.

Chook said:

I have a HbA1c every six months (they contact me by letter telling me to make an appointment for the blood taking) but only have a review once a year. This year (and the past few years) the review was with a Health Care Assistant who could only ask the questions on her monitor - when it came to discussing medication (I wanted to reduce Metformin) and other stuff all she kept saying was that I should make an appointment with a doctor. It's been a few years since I had any kind of review with a properly qualified person who is able to do more than tick boxes on a computer screen.

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To be fair, I have always regarded the HCA reviews as a data collection exercise. My GP gets the results from the BP, the blood tests and urine analysis , and checks that all is well. He rings me if there is a problem or I need an appt or a re-test. Our HCA does the mandatory foot checks, but again this is not a highly specialised task either. Yes, meds get discussed, and the HCA adds notes to record if I make any requests to change. I sometimes leave a letter at reception for GP if I have any specific problems, but generally I see my GP for my non diabetic conditions nowadays since for me those are much more life threatening than my well controlled bgl. My GP is very good at notifying me if he detects any trending issues, such as my recent low sodium levels.

Because I self check my bgl, then I have a good idea where my HbA1c is likely to fall. It is a tick box exercise for the NHS, but it does not tell me any more than I already know.

It is necessary for anyone not taking their own readings of course and is important to many with diabetes who do not have the support I have. The NICE guidelines do not help in this respect especially for T2D and this is not likely to change in the near future sadly. But the HbA1c test is no substitute for SMBG testing or the use of CGM,

Oldvatr said:

But the HbA1c test is no substitute for SMBG testing or the use of CGM,

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I could not agree more. The HbA1c has many faults, but can be used by the nurse/doctor to spot upward and downward trends so has its uses in that respect. As for anything else it is not a useful tool. Self testing and CGM/Libre devices are the best indicators of how well we are doing and whether we are experiencing unacceptable and dangerous roller coaster levels. The HbA1c does not pick these up. It just gives a sort of average and relies on us all having standard red blood cell counts and life spans. I use my own testing regimes and part time Libre sensors to monitor my blood glucose. The HbA1c just keeps the nurse happy. (or not)

If I find the nurse doesn’t cut the mustard at review, I just make an appointment with the doc.

Bluetit1802 said:

I could not agree more. The HbA1c has many faults, but can be used by the nurse/doctor to spot upward and downward trends so has its uses in that respect. As for anything else it is not a useful tool. Self testing and CGM/Libre devices are the best indicators of how well we are doing and whether we are experiencing unacceptable and dangerous roller coaster levels. The HbA1c does not pick these up. It just gives a sort of average and relies on us all having standard red blood cell counts and life spans. I use my own testing regimes and part time Libre sensors to monitor my blood glucose. The HbA1c just keeps the nurse happy. (or not)

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Agree heartily. In my opinion HbA1c as a sole metric is overrated. It means little without accompanying incremental glucose data, and both are ultimately overrated in determining metabolic health without accompanying insulin data.

Atad heavy said:

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.

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Thats daft as the "lab door cost" at my local NHS lab for a A1c is under £3.

ringi said:

Thats daft as the "lab door cost" at my local NHS lab for a A1c is under £3.

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But with more 3 million registered diabetics currently identified in the UK, then a 6 monthly check will cost twice as much as a yearly one, and even at £3 a pop, that is still several million added to the NHS costs, and dont forget to add in the HCP or GP time for assessing the test results and seeing the patient for all the other screening checks that are needed to support us on our journey, When you look at the overall picture, then it becomes significant,

I have a yearly HbA1c test as my diabetes is well controlled, in fact when it went down to 37 I was told off by DN as she thought that was too low. I also self test.

Remember that nearly all the cost of a simple blood test are outside of the lab and do not increase by adding additional test. So a big difference between refusing to add a A1c to a blood sample that is already being taken, to refusing to take blood samples more often.

Atad heavy said:

I have never had a review with a Dr only diabetic nurse

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Me too. The GP delegates all T2 care to a nurse. My nurse is brilliant and knowledgeable. She knows far more than the GP does. In fact, I have never seen a GP for diabetes. Even my nurse saw me for my diagnosis. I think this is the general rule in most surgeries.

Atad heavy said:

I take your point but they actually diagnose you on the HbA1c results alone

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Because apart from the OGTT and fasting blood glucose it is the only diagnostic test available on the NHS

Atad heavy said:

As I understand it diabetes is a progressive disease and I have read posts about sudden increase in HbA1c

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If you read the Success Stories section of the Forum, you will find many examples of people achieving remission from the condiion. I am one of those, and boy was I surprised when the doctor pulled my diabetic meds saying I did not need them, It turned out he was right, and I had a spell of being able to eat normally, including celebratory pecan croissants, without spiking anymore. No meds, HbA1c below 48 twice, and I was a happy bunny. However, I underwent a major operation that triggered severe trauma, and my diabetes was not able to cope with very poor hospital food. I have since repaired much of that damage, and am hopeful of being back in remission in a month or so.

There are instances when the pancreas stops producing insulin and yes, the HbA1c can increase suddenly as a result. However, I believe that the first sign of trouble is not an HbA1c but via hospital A&E with DKA symptoms, There may be periods of raised HbA1c before this event that can be a warning, but the frequency of the tests will not nomally pick up a sudden failure of the pancreas. I was feeling fine and 'healthy' when my HbA1c was over 100, but my pancreas is happily giving me oodles of insulin as my recent remission has demonstrated. My recent hospital visit where my pancreas actually did stop producing insulin, and I needed infusions for a while, was detected by fingerprick tests, and not by any blood test such as HbA1c. In fact my HbA1c on discharge after was only 51 so not diagnostic at all.