Evaluating point-of-care testing for glycosylated haemoglobin in public sector primary care facilities in the Western Cape, South Africa

Mash, Robert; Ugoagwu, A; Vos, Corné de; Rensburg, Megan; Erasmus, Rajiv T

doi:10.7196/samj.2017.v106i12.10728

Cited by 12 publications

(20 citation statements)

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“…[7][8][9][10][11] So far, limited studies have been conducted in SA to determine whether HbA1c POCT has benefits similar to those documented elsewhere. In the report on their study in the Western Cape, Mash et al [13] suggested that POCT for HbA1c showed no benefits in improving glycaemic control in public sector primary care practice. They further commented that POCT should be re-evaluated in the context of an improved multifaceted approach targeting both the RESEARCH clinician and the primary healthcare setting.…”

Section: Discussionmentioning

confidence: 98%

“…Limited data on the benefits on diabetes control of HbA1c POCT exist in SA. Mash et al [13] suggested in their report on a study conducted in the Western Cape Province that the effects of HbA1c POCT should not be evaluated in isolation but rather in combination with strategies to improve clinician inertia, coupled with stronger primary healthcare. [13] A multifaceted approach to diabetes care was introduced at the diabetes clinic at Edendale Hospital (EDH), Pietermaritzburg, KwaZulu-Natal, in 2012.…”

Section: Researchmentioning

confidence: 99%

“…Mash et al [13] suggested in their report on a study conducted in the Western Cape Province that the effects of HbA1c POCT should not be evaluated in isolation but rather in combination with strategies to improve clinician inertia, coupled with stronger primary healthcare. [13] A multifaceted approach to diabetes care was introduced at the diabetes clinic at Edendale Hospital (EDH), Pietermaritzburg, KwaZulu-Natal, in 2012. [14] Improved clinician and nurse education on diabetes, based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines, was integral to this approach.…”

Section: Researchmentioning

confidence: 99%

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Validation and effect on diabetes control of glycated haemoglobin (HbA1c) point-of-care testing

et al. 2019

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Background. Optimal control of diabetes mellitus (DM) remains daunting globally. Point-of-care testing (POCT) for glycated haemoglobin (HbA1c) enables the clinician to make immediate management decisions and thereby improve DM control and complications. Better control is increasingly being striven for in developing countries where availability of POCT devices is limited. Methods. Every alternate patient who visited the diabetes clinic at Edendale Hospital, Durban, South Africa, between 1 June 2017 and 31 August 2017 was invited to participate in the study. These patients made up the POCT group, with the remainder making up the control laboratory group. The POCT group had Quo-Test HbA1c POCT done at the clinic visit and their treatment was adjusted based on the HbA1c reading, while the control group received standard treatment. The two groups of patients were reviewed at 3 months to identify differences in diabetes control between them. Results. Data from 266 patients were analysed (135 in the POCT group v. 131 in the control group). There was no significant difference between the price of the POCT and laboratory HbA1c tests (p=0.823). The POCT and laboratory HbA1c values showed good correlation at baseline (r=0.995; p<0.001). The two groups of patients were evenly matched in respect of most demographic and clinical variables. Patients in the POCT group showed a significant improvement in mean (standard deviation) glycaemic control between baseline and 3 months (9.61 (2.46) v. 8.98 (2.15); p<0.043). No improvement was noted in the control group (9.58 (2.49) v. 9.43 (2.15); p=0.823). Conclusions. The Quo-Test HbA1c POCT had good correlation with standard laboratory methods in respect of both glycaemic control and price. Patients who had POCT at baseline showed a significant improvement in glycaemic control at 3 months. HbA1c POCT in the setting of a multifaceted approach to diabetes care has been shown to have definite benefits.

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Section: Discussionmentioning

confidence: 98%

Section: Researchmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

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Validation and effect on diabetes control of glycated haemoglobin (HbA1c) point-of-care testing

et al. 2019

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“…Despite feasible, easily implementable access to POC and readily available guidelines, there was no improvement in treatment intensification, no increase in POC usage and no improved glycaemic control. (10) Why did glycaemic control get worse? Perhaps there are limitations inherent to institutions as suggested by Khunti et al(11), who found that follow-up dates for patients were fixed and did not depend on the outcome of the consultation.…”

Section: Discussionmentioning

confidence: 99%

“…A prospective randomised controlled trial published in 2016 looked at the Cape Town community health centres in South Africa. (10) The investigators assessed whether introducing POC would reduce the direct costs of diabetic care including staff costs, test and consumables, as well as transport and time costs for patients. The control arm was usual care with an annual laboratory HbA1c.…”

Section: Introductionmentioning

confidence: 99%

Has Glycaemic Control in Diabetes Mellitus Improved Since the Introduction of Point-of-Care Glycated Haemoglobin A1c?

Constance¹,

Frederick²

2020

Wits Journal of Clinical Medicine

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Background: The mortality rate from diabetes-related complications in Sub-Saharan Africa surpassed that of HIV/AIDS, tuberculosis and malaria combined. Point-of-care (POC) glycated haemoglobin (HbA1c) has been in routine use at a tertiary hospital's diabetic clinic in Johannesburg, South Africa. This study set out to determine if having a readily available result on the day of consultation has led to improved glycaemic control. Objective: The aim of this study was to determine if an immediately available POC HbA1c would result in more patients achieving target HbA1c compared to previously used laboratory HbA1c. Methods: A retrospective audit of 195 attendees of the diabetic clinic at a public academic hospital who had been attending before the advent of the POC HbA1c test was recruited. The laboratory HbA1c taken on average 5 years before was compared to the current POC HbA1c to determine if there was any improvement in glycaemic control. Results: The mean HbA1c before the POC test was 8.8% (SD 1.9) and the current POC HbA1c was 8.9% (SD 1.94). There was no statistically significant improvement in glycaemic control. Conclusion: The POC test for HbA1c at a tertiary hospital's diabetic clinic did not result in improved glycaemic control. This study has shown that the introduction of new technology alone may not result in better diabetic care. Comprehensive diabetic care is multifactorial and relies on the intensive efforts of a multidisciplinary team including physician and diabetic nurse educator with active patient participation to ensure optimal glycaemic control.

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Point-of-Care testing of HbA1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis

Gourlay,

Sutherland,

Radley

2024

Primary Care Diabetes

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Evaluating point-of-care testing for glycosylated haemoglobin in public sector primary care facilities in the Western Cape, South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 12 publications

References 0 publications

Validation and effect on diabetes control of glycated haemoglobin (HbA1c) point-of-care testing

Validation and effect on diabetes control of glycated haemoglobin (HbA1c) point-of-care testing

Has Glycaemic Control in Diabetes Mellitus Improved Since the Introduction of Point-of-Care Glycated Haemoglobin A1c?

Point-of-Care testing of HbA1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis

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