Experience of point-of-care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study

Abstract

IntroductionTo report the observations of point-of-care (POC) glycated hemoglobin (HbA1c) testing in people with non-diabetic hyperglycemia (NDH; HbA1c 42–47 mmol/mol (6.0%–6.4%)), applied in community settings, within the English National Health Service Diabetes Prevention Programme (NHS DPP).Research design and methodsA service evaluation assessing prospectively collected national service-level data from the NHS DPP, using data from the first referral received in June 2016–October 2018. Individuals were referred to the NHS DPP with a laboratory-measured HbA1c in the NDH range and had a repeat HbA1c measured at first attendance of the program using one of three POC devices: DCA Vantage, Afinion or A1C Now+. Differences between the referral and POC HbA1c and the SD of the POC HbA1c were calculated. The factors associated with the difference in HbA1c and the association between POC HbA1c result and subsequent attendance of the NHS DPP were also evaluated.ResultsData from 73 703 participants demonstrated a significant mean difference between the referral and POC HbA1c of −2.48 mmol/mol (−0.23%) (t=157, p<0.001) with significant differences in the mean difference between devices (F(2, 73 700)=738, p<0.001). The SD of POC HbA1c was 4.46 mmol/mol (0.41%) with significant differences in SDs between devices (F(2, 73 700)=1542, p<0.001). Participants who were older, from more deprived areas and from Asian, black and mixed ethnic groups were associated with smaller HbA1c differences. Normoglycemic POC HbA1c versus NDH POC HbA1c values were associated with lower subsequent attendance at behavioral interventions (58% vs 67%, p<0.001).ConclusionPOC HbA1c testing in community settings was associated with significantly lower HbA1c values when compared with laboratory-measured referrals. Acknowledging effects of regression to the mean, we found that these differences were also associated with POC method, location, individual patient factors and time between measurements. Compared with POC HbA1c values in the NDH range, normoglycemic POC HbA1c values were associated with lower subsequent intervention attendance.

The effectiveness of digital delivery versus group-based face-to-face delivery of the English National Health Service Diabetes Prevention Programme: a non-inferiority retrospective cohort comparison study

“…Previous work has suggested point-of-care tests tend to give lower values than venous methods. 31 We were uncertain how much impact differences in measurement would have. Secondly, only 21.3% of the face-to-face cohort provided baseline and 6-month measures, making the matching pool too small to identify the required number of matches.…”

A Comparative Evaluation of HbA1c Measurement Methods and Their Implications for Diabetes Management

“…The overall average HbA1c level of 7.857% among DM-diagnosed participants suggests that, on average, these individuals have moderately elevated HbA1c levels. This indicates that the study population, as a whole, may be experiencing suboptimal blood sugar control [19,23]. Elevated HbA1c levels are associated with an increased risk of diabetes-related complications, highlighting the importance of improving diabetes management strategies [23,25].…”

“…LIFA offers advantages such as cost-effectiveness, ease of use, and rapid results [11,17]. Its quantitative feature overcomes the limitations of standard qualitative LIFA tests, thereby enhancing the accuracy and reliability of HbA1c measurements [13,19]. With the ongoing developments in LIFA technology and continuous evaluation of various instruments, the clinical utility of HbA1c measurements using LIFA can be further enhanced [12,19].…”

Attendance, Weight Loss, and Participation in a Behavioural Diabetes Prevention Programme

“…Additional information on the exact sessions that each participant attended could reveal patterns of attendance, especially since weight loss from session to session is an important factor of subsequent dropout [ 34 ]. Fourth, the lack of HbA1c information, as low values of HbA1c measurement during the programme is another potential predictor of dropout [ 35 ]. The provider aimed to measure HbA1c at substantially less frequent intervals than weight, thus ruling out any analysis of the association between HbA1c change and sessions.…”