Monitoring of Diabetic Patients with Poor Glycemic Control. Are International Recommendations Met?

BACKGROUND-AIM: Diabetes mellitus is one of the most prevalent diseases worldwide. According to the ADA 2020 guidelines, individuals with unstable glycemic control should be monitored every three months by measuring glycated hemoglobin (HbA1c). The aim of this study was to evaluate the demand adequacy for HbA1c in the monitoring of patients with diabetes mellitus with a highly unstable glycemic control. METHODS: Retrospective observational study (2016-2019). All HbA1c tests from individuals ≥18 years requested by hospital physicians were considered. Highly unstable glycemic control was defined as HbA1c≥10.0%, and their monitoring was classified as: optimal, out of recommendations (if>3months) and lack of monitoring if no further HbA1c measurement was performed by the laboratory. For individuals classified as lack of monitoring, medical records were reviewed and further re-classified as: [1] due to patient’s responsibility, [2] attributable to the requesting physician, [3] monitored by POCT, [4] unfeasibility of monitoring or [5] referral outside our area for follow-up. RESULTS: During the assessed period, 1,156 patients had an HbA1c value≥10.0%. 67.5% of them were monitored either in the clinical laboratory or as POCT (33.7% optimal monitoring), whereas 21.0% patients were not monitored due to preventable situations. CONCLUSION: Lack of monitoring due to physician’s reasons or patient’s responsibility highlights the urgent need for an improvement.