Diabetes Audit search folder

Diabetes Audit search folder

GLP-1 agonist stock shortage

This folder created specifically in response to the July 2023 GLP-1 stock shortage sits within the Diabetes folder of 012 Clinical Searches. It is also available as a standalone folder to support a rapid deployment to sites.
The top level search has been built to identify patients who are affected by the shortage. This means that the folder should not be used as supplied to identify all patients on GLP-1 agonists as lixisenatide (and albiglutide) is not subject to the alert.



GLP-1 initiated in last 2 years
This search identifies patients who started a GLP-1 in the 2 years prior to the search date to support Practices carrying out a proactive review of patients on GLP-1s. The report can be used as the first part of the review as it extracts relevant information relating to the GLP-1 drug as well as IFCC HbA1c and weight values. Reviewers can use the figures provided to calculate the percentage improvement in HbA1c and weight since each patient started a GLP-1. There are windows around each 'initiation' plus the latest result (which may happen to be a duplicate of an adjacent column).

... before GLP initiation
The most recent result prior to the 1st issue of the 1st GLP-1 in the last 2 years. In most cases it would be expected that this result was within 6 months of initiation. If the interval is longer, or no code seen, consider coding configuration of results.
... 3+ months after initiation
All results with an attached value between 3 and 11 months after the 1st issue of the 1st GLP-1 in the last 2 years. These values can be used to begin to calculate any reduction in HbA1c or weight at around the 6 month point.
... 12+ months after initiation
The 1st result which is at least 12 months after the 1st issue of the 1st GLP-1 in the last 2 years.



The current GLP-1 medication may not be the same as the GLP-1 medication that the patient was first prescribed.
Any empty cells where a value might be expected would indicate that the patient has not been reviewed within the timeframes.

Patients who were on a GLP-1 between 2 and 3 years ago but changed to a different GLP-1 in the last 2 years are not included.

Review 1 - Children and Young People
Children and young people with T2DM prescribed GLP-1 RAs under the care of specialist paediatric services should be directed back to specialist services.

Review 2 - No diabetes/licensed indication
Identifies any patient who does not have an unresolved diagnosis of diabetes.  Patients on a GLP-1 for weight loss would have prescriptions issued by secondary care, so issues on EMIS Web marked Hospital or Record for notes will not be shown.

Review 3 - Established Rx but last HbA1c >86
Patients who have been on a GLP-1 for at least 90 days and whose HbA1c is elevated should be prioritised for review. It would be necessary to review each patient's record to observe the history and trend of HbA1c results.

Review 4 - HbA1c was >86 before GLP1
Consider prioritising review for people with Type 2 Diabetes whose HbA1c was more than 86 at the point they started their current (active) course of GLP-1.

Review 5 - No HbA1c in the past 6 months
There is no coded IFCC HbA1c result in the last 6 months. Prioritise patients for a blood test (and a review).

Review 6 - Latest urine ACR >30mg/mmol
Consider prioritising patients whose most recent albumin:creatinine ratio is at least 30.

Review 7 - Coded 'Hyperglycaemia'
Patients who have had a hyperglycaemic event at least 30 days after starting their current GLP-1.

CONSIDER A REVIEW
This search pulls together all patients identified in Reviews 1-7. Remember some patients may appear in two or more Review cohorts.

Support Information

Development Log

VERSION NUMBER

v1.0
Published 27/07/2023
Release notes:

Communications Log

Supporting Subscribers with NatPSA/2023/008/DHSC

Shortage of GLP-1 Receptor Agonists

To support our subscribers in processing action points from this National Patient Safety Alert  related to GLP1–RA shortages, Primary Care IT is pleased to share a cluster of searches that should help you to identify patients recommended for clinical review by the Primary Care Diabetes Society (PCDS). 

We have built out searches that specifically pick out patients who may need a more detailed review or conversation with a view to stopping their therapy or changing overall strategy, in line with the shared decision-making recommended by the NPSA and PCDS.

Practices or their pharmacy teams can run all searches in the folder at the same time, or just run the audit report RWA-216-AUDIT) On GLP-1 RA - CONSIDER REVIEW to get an interactive overview of the patients suggested for review. 
 

Link to PCDS Guidance

We hope you find these resources useful.

The team at Primary Care IT



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