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Tough new QOF diabetes target could lead to more hypos

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New targets for tight glycaemic control in the GP contract could increase the risk of hypoglycaemia in patients with type 2 diabetes, nurse specialists have warned.

The 2009–2010 version of the quality and outcomes framework (QOF), published in March, set tougher targets for blood glucose control than the previous year, with GP practices now aiming for 50% of patients with type 2 diabetes to have a blood glucose level of 7% or less. The previous target was 7.5%.

But diabetes nurse specialists (DNSs) have expressed concerns that the pressures placed on practices to meet the new QOF target could make some patients more vulnerable to hypoglycaemic episodes.

‘Tight glycaemic control is not appropriate for all patients, such as those living alone or the elderly, and targets need to be realistic and set for individual patients,’ said Sinead Dawes, DNS at Aintree University Hospitals NHS Foundation Trust in Liverpool.

‘GPs need to balance the risks associated with aiming for tight glycaemic control with patient safety and quality of life,’ she added.

Patients on sulphonylurea (SU) therapy – a group of oral anti-diabetic drugs – are at particularly high risk of hypoglycaemic events. Researchers estimate that each year in the UK more than 5,000 patients will have a severe hypoglycaemic episode relating to the drugs, requiring hospital emergency treatment costing around £1,000.

NICE guidelines on new treatments for patients with type 2 diabetes, published last week, have addressed this issue to some degree by recommending new therapies that do not increase the risks of hypoglycaemia.

But many patients will still be on SU therapy, and nurses need to educate them about the risks associated with this type of treatment, said Sue Cradock, nurse consultant in diabetes at Portsmouth Hospitals NHS Trust.

‘While sulphonylureas are valuable drugs in the treatment of type 2 diabetes, they should be used with caution in the elderly or in anyone where the risk of hypoglycaemia outweighs the benefits of the drug,’ she told Nursing Times.

‘All healthcare practitioners working with people with diabetes need to be aware which of their patients are on therapies that could induce hypoglycaemia. They can then provide structured education to help people recognise when they are likely to be at risk, and how to prevent and treat hypoglycaemic episodes,’ she added.

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Readers' comments (1)

  • I am a practice nurse and I have recently had an increase in patients previously managed by the hospital being discharged to GP-led care. This means that we are taking responsibility for the more hard-to-control patients ourselves, and coupled with these tighter targets I can forsee more of these hypoglycaemic episodes occurring in future. The Government's response would no doubt be that we as a practice should exclude those people for whom we feel the target inappropriate. However, there is intense scrutiny shown to those cases we do exclude, so that there is no temptation to exclude patients in order to meet the targets, rather than for genuine reasons. This means either more patients will be put at risk of hypoglycaemia, or the target will be unachievable, which I have no doubt is the Government's aim, to reduce the QOF bill.

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