title: Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines?
abstract: OBJECTIVE
  To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing.
  
  
  METHODS
  Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months.
  
  
  METHODS
  Of 13 105 individuals who had either a single HbA1c result ≥7.0% (53 mmol mol-1); or two or more HbA1c tests within the study period.
  
  
  METHODS
  Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations.
  
  
  RESULTS
  About 58.3% of patients did not have the recommended 6-monthly HbA1c tests and 30.6% did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95% CI = 7.5-13.5) rather than 6 months for HbA1c testing; and 15.7 (95% CI = 13.3-18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77% of patients failed to receive a follow-up HbA1c test and 86.5% failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001).
  
  
  CONCLUSIONS
  Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.
authors.affiliation: Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.|School of Medicine and Public Health, Callaghan, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Paul
authors.affiliation: Department of General Practice, Berwick and Peninsula Campuses, Monash University, Berwick, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Piterman
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Melbourne, Australia.|Clinical Diabetes and Epidemiology Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: Department of General Practice, Berwick and Peninsula Campuses, Monash University, Berwick, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kirby
authors.affiliation: School of Medicine and Public Health, Callaghan, Australia.|Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Barker
authors.affiliation: School of Medicine and Public Health, Callaghan, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.|School of Medicine and Public Health, Callaghan, Australia.
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Forshaw
authors.affiliation: Melbourne Pathology, Sonic Healthcare, Melbourne, Victoria, Australia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Sikaris
authors.affiliation: Hunter Medical Research Institute, CReDITSS, New Lambton Heights, New South Wales, Australia.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bisquera
authors.affiliation: Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.|School of Medicine and Public Health, Callaghan, Australia.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sanson-Fisher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D019983:Guideline Adherence; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids
keywords: HbA1c; diabetes mellitus; patient care management; rural health; vulnerable populations