Availability and analytical quality of hemoglobin A_1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_cclm-2020-0026_s_999_w2aab3b8b1b1b7b1aab1c14b1Aa"><jats:title>Background</jats:title><jats:p>It is not clear if point-of-care (POC) testing for hemoglobin A<jats:sub>1c</jats:sub> (HbA<jats:sub>1c</jats:sub>) is associated with glycemic control in type 2 diabetes.</jats:p></jats:sec><jats:sec id="j_cclm-2020-0026_s_998_w2aab3b8b1b1b7b1aab1c14b2Aa"><jats:title>Methods</jats:title><jats:p>In this cross-sectional study, we linked general practitioner (GP) data on 22,778 Norwegian type 2 diabetes patients to data from the Norwegian Organization for Quality Improvement of Laboratory Examinations. We used general and generalized linear mixed models to investigate if GP offices’ availability (yes/no) and analytical quality of HbA<jats:sub>1c</jats:sub> POC testing (average yearly “trueness score”, 0–4), as well as frequency of participation in HbA<jats:sub>1c</jats:sub> external quality assurance (EQA) surveys, were associated with patients’ HbA<jats:sub>1c</jats:sub> levels during 2014–2017.</jats:p></jats:sec><jats:sec id="j_cclm-2020-0026_s_997_w2aab3b8b1b1b7b1aab1c14b3Aa"><jats:title>Results</jats:title><jats:p>Twenty-eight out of 393 GP offices (7%) did not perform HbA<jats:sub>1c</jats:sub> POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA<jats:sub>1c</jats:sub> levels (95% confidence interval (0.04–0.27) (1.7 mmol/mol [0.5–2.9]). GP offices participating in one or two yearly HbA<jats:sub>1c</jats:sub> EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA<jats:sub>1c</jats:sub> levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices’ HbA<jats:sub>1c</jats:sub> POC analytical trueness score, the patients’ HbA<jats:sub>1c</jats:sub> levels were lower by 0.04% HbA<jats:sub>1c</jats:sub> (−0.09, −0.001) (−0.5 mmol/mol [−1.0, −0.01]).</jats:p></jats:sec><jats:sec id="j_cclm-2020-0026_s_996_w2aab3b8b1b1b7b1aab1c14b4Aa"><jats:title>Conclusions</jats:title><jats:p>Novel use of validated patient data in combination with laboratory EQA data showed that patients consulting GPs in offices that perform HbA<jats:sub>1c</jats:sub> POC testing, participate in HbA<jats:sub>1c</jats:sub> EQA surveys, and maintain good analytical quality have lower HbA<jats:sub>1c</jats:sub> levels. Accurate HbA<jats:sub>1c</jats:sub> POC results, available during consultations, may improve diabetes care.</jats:p></jats:sec>

Cohort profile: Outcomes & Multi-morbidity In Type 2 diabetes (OMIT) – a national registry-based observational cohort with focus on care and treatment of key high-risk groups in Norway

“… 15 Another ROSA4 study indicated that point-of-care HbA 1c testing in general practice was linked to better glycaemic regulation in patients with T2D. 20 Finally, ROSA4 has reported that GP adherence to recommended standard follow-up procedures in T2D was related to both clinic structure and workload. 21 …”

Setting analytical performance specifications using HbA1c as a model measurand

“…Operational and economic outcomes can also be taken into account when setting APS, provided that patient health outcomes are not unduly compromised. For example, HbA1c measured using a point of care device with low bias in the clinic facilitates faster decisions on the adjustment of treatment, which can be better communicated to patients at their clinic visit and thus leads to increased adherence with treatment [7]. This raises the important concept of balancing priorities for both health outcomes and costs.…”

Point‐of‐care testing—Has it come of age?

“…The provision of a glycated haemoglobin (HbA1c) result by PoCT at the time of consultation leads to improvement in glycaemic control. 3 In addition, GPs have long argued that PoCT also brings other benefits to their everyday practice.…”