Overuse of HbA1c testing may be common in nursing home residents with diabetes
HbA1c levels were tested frequently even in patients not taking medications for their diabetes, those taking medications with low risk for hypoglycemia, and those whose HbA1c levels were in the target range, a Canadian study found.
Nursing home residents with diabetes may undergo HbA1c testing more frequently than necessary, a recent study found.
Researchers conducted a population-based retrospective study using health administrative data from April 1, 2021, to March 31, 2022, among nursing home residents in Ontario, Canada, who had diabetes and were age 66 years or older. The goals of the study were to evaluate rates of diabetes monitoring and screening for dyslipidemia and diabetic microalbuminuria. Frequency and rate of HbA1c and serum glucose testing over one-year were the primary outcomes. The researchers also assessed the use of capillary glucose testing, intermittently scanned continuous glucose monitoring (CGM), serum lipid testing, and urine albumin-to-creatinine ratio testing in secondary analyses. The results were published as a research letter Sept. 20 by the Journal of the American Geriatrics Society.
Overall, 25,005 nursing home residents were included in the study (62.1% women; mean age, 83.69 years; mean duration of diabetes, 16.12 years). During the one-year study period, 81% of residents had at least one HbA1c test, and 46% had three or more. Serum glucose was tested in 55% of residents, with 20% receiving three or more tests. Forty-three percent of residents were given capillary glucose strips, with 20% receiving three or more per day; intermittently scanned CGM sensors were dispensed to 18% of residents, with 10.2% receiving at least two sensors per month.
Urine albumin-to-creatinine ratio and serum lipids were tested during follow-up in 7.3% and 29% of residents, respectively. Subgroup analyses found that HbA1c testing was more commonly done in men, in younger residents (defined as those <80 years of age), in patients with an HbA1c level of 7.1% to 8.5% or above 8.5%, and in those taking diabetes medications, particularly insulin or secretagogues. Trends for serum glucose testing were similar.
The study results suggest that many patients with diabetes who reside in nursing homes may be receiving unnecessary testing, the authors concluded, noting that HbA1c testing rates were high even in those who weren't taking diabetes medications, whose medications had a low risk for hypoglycemia, or whose HbA1c levels were in the target range.
“One possible explanation for frequent A1c testing is the absence of specific diabetes testing guidelines for older adults with frailty,” the authors wrote. “Interestingly, this pattern contrasts with the observed low rates of albumin-to-creatinine ratio (ACR) and lipid testing, for which clearer guidance exists, particularly regarding reduced lipid screening for primary prevention in older adults.” They called for evidence-based, consensus-driven guidelines to assess the need for frequent diabetes testing in nursing homes, given limited resources, minimal benefits, and risk for harm.