Gaps identified by ANDA audit should trigger a “call to action”

Australia’s diabetes centres are falling short on timely screening, glycemic control and managing cardiovascular risk, a conference has been told.

Presenting at ADC 2018, clinical research fellow Eleanor Danek said findings from the latest 2017 Australian National Diabetes Audit suggest while diabetes centres are generally managing patients well, several gaps in management should be seen as a “call to action”.

Last year, 63 diabetes centres (two-thirds were tertiary centres including centres of excellence) who treated a total 5719 patients took part in the annual audit that is funded by the federal Department of Health.

“We found a number of patients were on anti-hypertensive medications, but they hadn’t been sufficiently titrated because 54% still had raised blood pressure and 37% on lipid lowering treatments still had high cholesterol levels, and we have flagged that as a treatment gap,” she told the limbic.

“We also found prescribing gaps for people with cardiovascular risk factors; 11% of people with raised blood pressure weren’t on anti-hypertensive medications and 11% with high cholesterol were not on lipid lowering medications.”

The researchers also identified that between centres there were significant differences in the rates of severe hypoglycaemia experienced by patients, after adjusting for non-care related factors like BMI and disease severity.

“So what that highlights to us is there is a lot of variation in the way diabetes centres are tackling prevention of severe hypoglycaemia.”

Additionally, 26% of patients had not been screened for kidney disease and 39 % had not been screened for retinopathy within the last year, as per best practice recommendations, she said.

Alarmingly, half or more patients were above target measurements for blood pressure, lipid levels and BMI set by the National Vascular Disease Prevention Alliance.

While the use of interventions that target reducing cardiovascular risk and glycemic control “would seem intuitive, we have the clear data showing they are not being sufficiently implemented,” she told the limbic.

“I think this is a call to action for diabetes centres and clinicians to focus on these and think about the structures they can put in place to ensure that these things get done.”

“For example some kind of recall system to remind patients who come in for their yearly retinal screening test or kidney screening test, structures that will help address these things, even though they seem quite obvious and the sort of things every clinician should be doing.”

“Endocrinologists and GPs need to work in tandem to ensure that screening gets done and prescribing gaps are reduced,” she said. “The way forward is ongoing education – using this data to educate clinicians and spread this data so it can be used to empower diabetes centres to change their practice to improve outcomes for patients.”

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