Diabetes care: can QOF miss the point? Unexpected improvement in diabetes control should prompt a search for an underlying cause

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Abstract

The Quality and Outcomes Framework for diabetes mellitus has led to an improvement in diabetes management since its introduction in 2004. However, the focus on reduction of HbA1c must not detract from a holistic approach to patient care.

We present the case of a patient whose unexpected decline in HbA1c levels culminated in an emergency presentation to hospital, where Addison's disease was diagnosed. Features of adrenal insufficiency were present prior to acute admission.

We review the presenting features of Addison's disease and discuss the differential diagnosis of reduced HbA1c in diabetic patients. Copyright © 2013 John Wiley & Sons.

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