GP surgeries in England and Wales have been offered two new financial incentives related to type 1 diabetes treatment and management.
The financial incentives are part of the Quality and Outcomes Framework (QOF), which “rewards practices for the provision of quality care and helps standardise improvement in the delivery of primary medical services”, according to the Health and Social Care Information Centre.
The new QOF incentives will be offered to GP surgeries for:
- Prescribing statins to patients with type 1 diabetes that are over 40 years of age or have had diabetes for over 10 years.
- Patients that achieve HbA1c levels of 58 mmol/mol or less (the previous QOF award was for an HbA1c level of 59 mmol/mol or less)
The QOF rewards are in line with the controversial NICE guidelines on lipid modification. The decision to offer statin treatment to people with type 2 diabetes is dependent on whether they have a 10-year risk of developing heart disease, based on an algorithm. However, for type 1 diabetes, the risks are less well understood and a blanket approach related to age and duration of diabetes has been applied.
The QOF means that many young adults with type 1 diabetes will be offered and prescribed statins if they have had the condition for more than 10 years, regardless of whether their cholesterol levels are healthy or not.
Older people may be put at risk if GPs are not careful. Statins lower cholesterol levels, and while the lowering of cholesterol is widely regarded by healthcare professionals as beneficial, but studies are less clear on the benefits. Furthermore, elderly patients face an increased risk of earlier death if cholesterol levels become too low.
Data from National Diabetes Audits show that patients with cholesterol levels below 3 mmol/l have the highest mortality rates of any cholesterol bracket.
In general, prescribing statins to people at risk of heart disease has shown evidence that taking the drugs for three years, reduces the risk of a major heart event in one in a hundred patients. However, to date, the outcomes specifically related to people with type 1 diabetes are not known.