A1c Monitoring Could Be Delayed Up to 2 Years for Patients With Type 2 Diabetes

For patients with type 2 diabetes (T2D) who have a hemoglobin A_1c (HbA_1c) of less than 7%, glucose monitoring can be extended to approximately 1.5 to 2 years, according to investigators of a study published in BJGP Open. For patients with an HbA_1c of 7% to 7.9% and 8% or greater, monitoring should be performed every 6 and 3 months, respectively.¹

“This target trial emulation study suggested that tailoring monitoring intervals according to patients’ recent HbA1c levels may be a practical approach for long‑term management in T2DM,” the study authors wrote.¹

An A_1c test can show a patient's average level of blood glucose over the past 2 to 3 months, as glucose can stick to hemoglobin for as long as red blood cells are alive, which is approximately 3 months. When checked at home, the blood glucose level will measure the level at the time that the patient tests it. For patients over 45 years, a provider will often determine how often they need to be tested based on age and risk factors. However, patients with prediabetes typically need to be tested every 1 to 2 years. Frisk factors for patients under 45 include prediabetes, obesity or overweight, familial history of T2D, high blood pressure, high cholesterol, and polycystic ovarian syndrome.²

In the current study, investigators aimed to determine general recommendations for appropriate A_1c monitoring intervals for patients with T2D at different levels during their long-term primary care, especially because no universal recommendation currently exists. Investigators included patients from January 1, 2009, to December 31, 2012, in Hong Kong, China. Patients were 18 years or older and received at least 2 HbA_1c tests within 2 years of the inclusion period.¹

For patients with a baseline HbA_1c of less than 7, investigators tested 4 intervals: 2 to 4 months, 5 to 8 months, 9 to 15 months, and 16 to 24 months. For patients with a baseline HbA_1c of 7% to 7.9%, 8% to 8.9%, and 9% or more, intervals included 2 to 4 months, 5 to 8 months, and 9 to 24 months. The primary outcome was all-cause mortality, and secondary outcomes included new incidences of major cardiovascular disease (CVD)—such as myocardial infarction, stroke, and congestive heart failure—and all 3 CVD outcomes separately.¹

Investigators included 183,078 patients, with 82,679 having an HbA_1c of less than 7, 57,672 having an HbA_1c of 7% to 7.9%, 24,595 having an HbA_1c of 8% to 8.9%, and 18,132 having an HbA_1c of 9% or more. For patients in the less than 7% HbA_1c group, there were no significant increases in the risk of all-cause mortality or major CVD events when extending the interval from 2 to 4 months to 5 to 8 months, 9 to 15 months, and 16 to 24 months. The hazard ratios (HR) for all-cause mortality were 1.00, 1.00, and 1.02, respectively, and for CVD events, the HRs were 0.98, 0.97, and 1.00, respectively.¹

For patients in the HbA_1c 7% to 7.9% group, extending the monitoring interval from 2 to 4 months to 9 to 24 months was significantly associated with all-cause mortality but not major CVD risk. Similarly, in the HbA_1c 8% to 8.9% group, both 5 to 8 months and 9 to 24 months were associated with an increased risk of all-cause mortality but not with major CVD risk. For patients in the HbA_1c 9% or greater group, less frequent monitoring was consistently associated with higher risks of adverse outcomes.¹

“The monitoring intervals identified in this study may serve as general recommendations for primary care in patients with T2DM,” the authors wrote.¹ “The observed associations between monitoring frequency and long-term outcomes may be explained by treatment adjustments made after each HbA1c review, which can influence glycaemic control and prognosis.”

READ MORE: Diabetes Resource Center

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