Impact of HbA1c Testing at Point of Care on Diabetes Management

Schnell, Oliver; Crocker, J. Benjamin; Weng, Jianping

doi:10.1177/1932296816678263

Cited by 104 publications

(83 citation statements)

References 70 publications

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“…11,34,35 The availability of POC A1c testing in our clinic may have facilitated prediabetes diagnosis and treatment, as patients receiving POC testing were more likely to receive metformin. POC testing in prediabetes management is not well studied; however, substantial evidence supports the benefits of POC testing for diabetes management 36 and limited evidence suggests it helps identify patients with prediabetes. 37 Promoting POC testing may be a relatively simple strategy to improve prediabetes screening, diagnosis, and treatment.…”

Section: Discussionmentioning

confidence: 99%

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

et al. 2019

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Lifestyle change programs are an effective but underutilized approach to prevent or delay type 2 diabetes in people with prediabetes. Understanding clinician prediabetes knowledge, attitudes, and practices can inform implementation efforts to increase lifestyle change program referrals. Methods: We surveyed clinicians at an academic family medicine clinic about their prediabetes knowledge, attitudes, and practices. From the same clinic, we reviewed electronic health records to assess prediabetes screening, diagnosis, and treatment coverage in the cohort of adults seen from 2015 to 2017. Results: Thirty-one clinicians (69.6%) completed the survey. Clinicians believed prediabetes was an important health issue (n ‫؍‬ 29; 93.7%) and that prediabetes screening (n ‫؍‬ 20, 64.5%) and diagnosis (n ‫؍‬ 31, 100%) were important for prediabetes management. About half of the respondents (n ‫؍‬ 14; 45.2%) reported familiarity with the National Diabetes Prevention Program (DPP). Electronic chart review included 15,520 adult patients. Most of the 5360 nondiabetic patients meeting US Preventive Services Task Force diabetes screening guidelines (n ‫؍‬ 4068; 75.9%) received a hemoglobin A1c test. Of the 1437 patients with an A1c result diagnostic of prediabetes, 729 (50.7%) had the diagnosis in their chart. Prediabetes patients receiving point-of-care A1c testing instead of laboratory testing had 4.7 increased odds (95% CI, 3.5 to 6.4) of metformin prescription. No patients were referred to a DPP. Conclusions: Clinicians' positive attitudes toward prediabetes screening, moderate knowledge of prediabetes management, and low awareness of DPPs were reflected by high diabetes screening coverage, limited prediabetes diagnosis, and no DPP referrals. We will tailor our implementation strategy to overcome these prediabetes care barriers.

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Section: Discussionmentioning

confidence: 99%

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

et al. 2019

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“…Other typical determination in T2D diagnosis is HbA1c, which was initially identified as an "unusual" hemoglobin, and has been correlated with glucose in several studies, suggesting the idea that HbA1c could be used as an objective measure of glycemic control [93]. HbA1c values represent the average glycemic control over the past 2-3 months and account for both, pre-prandial and post-prandial blood glucose levels [94]. Moreover, regular HbA1c measurement is recommended by different international guidelines for all patients with diabetes for the assessment of glycemic control [95].…”

Section: Carbohydrate Dysfunctionmentioning

confidence: 99%

Detection of Early Disease Risk Factors Associated with Metabolic Syndrome: A New Era with the NMR Metabolomics Assessment

et al. 2020

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The metabolic syndrome is a multifactorial disease developed due to accumulation and chronification of several risk factors associated with disrupted metabolism. The early detection of the biomarkers by NMR spectroscopy could be helpful to prevent multifactorial diseases. The exposure of each risk factor can be detected by traditional molecular markers but the current biomarkers have not been enough precise to detect the primary stages of disease. Thus, there is a need to obtain novel molecular markers of pre-disease stages. A promising source of new molecular markers are metabolomics standing out the research of biomarkers in NMR approaches. An increasing number of nutritionists integrate metabolomics into their study design, making nutrimetabolomics one of the most promising avenues for improving personalized nutrition. This review highlight the major five risk factors associated with metabolic syndrome and related diseases including carbohydrate dysfunction, dyslipidemia, oxidative stress, inflammation, and gut microbiota dysbiosis. Together, it is proposed a profile of metabolites of each risk factor obtained from NMR approaches to target them using personalized nutrition, which will improve the quality of life for these patients.

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“…In addition to HPLC, chemical and immunochemical assays have also been developed for HbA 1c measurement and the more recent versions of these assays are not affected by the haemoglobin variant interference. 13,14 A review of the recent literature is strongly recommended before purchasing a point of care HbA 1c analyzer, because the quality and analytical performance of these systems greatly varies. 15,16,17 As of today, there are only a few acceptable POCT HbA 1c analyzers are on the market.…”

Section: Point Of Care Hba 1c Testingmentioning

confidence: 99%

Point of care testing in the diagnosis and monitoring of diabetes mellitus

Ábel¹

2017

Diabetologia Hungarica

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In the past half-century, routine central laboratory testing has become increasingly automated and efficient. The majority of clinical chemistry, immunochemistry and hematology testing is performed using high throughput instrumentation, with sophisticated automation. Point of care testing offers considerable advantages over central laboratory testing such as fast and simple specimen handling, and simpler sample requirement (no additives and mostly blood from finger stick, or urine). The advantage of short turnaround time is particularly important in the inpatient setting for blood glucose monitoring to achieve tight glycaemic control. HbA 1c screening of inpatients, either with a central laboratory method or by means of point of care testing identifies patients previously not diagnosed with diabetes and enables enrolling of these patients in a diabetes treatment program. In the outpatient setting, point of care glucose and HbA 1c monitoring allow adjustment of therapy without the need of a second appointment in the doctor's office. In recent years, technology enabled patients to use point of care devices at home to assure tighter glucose control. However, point of care testing also has a downside: testing is more expensive than central laboratory testing, the accuracy and reproducibility of many point of care systems are no match to the analytical performance of the central laboratory tests, and performing the assays at home, by the patient's bedside, or in the office requires some skill. In addition, the accuracy of point of care testing in critically ill patients has been questioned recently, and the analytical performance of several commercially available point of care testing systems for HbA 1c has been found unacceptable. This article succinctly reviews the clinical utility of point of care blood glucose and HbA 1c testing in the diagnosis and monitoring of patients with type 2 diabetes mellitus, and discusses the caveats and limitations of point of care glucose and HbA 1c testing.

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Impact of HbA1c Testing at Point of Care on Diabetes Management

Cited by 104 publications

References 70 publications

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

Detection of Early Disease Risk Factors Associated with Metabolic Syndrome: A New Era with the NMR Metabolomics Assessment

Point of care testing in the diagnosis and monitoring of diabetes mellitus

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