A study of the differences in the request of glycated hemoglobin in primary care in Spain: A global, significant, and potentially dangerous under-request

Objectives: The study was performed to compare the variability and appropriateness in the request of glycated hemoglobin (HbA1c) in primary care in Spain. Design and methods: 76 Spanish laboratories from diverse regions across Spain filled out the number of HbA1c tests requested by general practitioners (GPs) during the year 2012. Every patient seen at the different primary care centers was included in the study. Each participating laboratory was required to provide organizational data. The number of HbA1c requests per 1000 inhabitants was calculated and compared between regions. To investigate whether HbA1c was appropriately requested to manage and to diagnose Diabetes Mellitus (DM), the number of necessary HbA1c was calculated, according to the disease prevalence in Spain (6.9%) and the guidelines regarding DM management and diagnosis. Results: 17679195 patients were included in the study. A total of 1544551 HbA1c tests were ordered. No significant difference in the number of HbA1c requests per 1000 inhabitants was seen according to hospital setting ( rural, urban or rural-urban). No significant differences were noticed between 3 Spanish regions, except the Valencian Community that presented higher values. Regarding the request appropriateness, 3280183 additional tests would have been necessary to manage diabetic patients and to diagnose new patients with the disease. Conclusion: There was a high variability regarding the request of HbA1c; the test was under-requested in all the participating health departments. This emphasizes the need to accomplish interventions to improve an appropriate use. (C) 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc.