Factors associated with potential over‐ and undertreatment of hyperglycaemia and annual measurement of HbA(1c) in type 2 diabetes in norwegian general practice

AIMS: To identify individual and general practitioner (GP) characteristics associated with potential over‐ and undertreatment of hyperglycaemia in type 2 diabetes and with HbA(1c) not being measured. METHODS: A cross‐sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA(1c) measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA(1c) was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA(1c) > 64 mmol/mol (8.0%) or HbA(1c) > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations. RESULTS: Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA(1c) measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non‐western origin and low educational level. Characteristics associated with not having an HbA(1c) measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs’ use of a Noklus diabetes application reduced the risk of not having an HbA(1c) measurement performed. CONCLUSION: Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de‐intensification or intensification of treatment and regular HbA(1c) measurement in identified subgroups is warranted.