Experience of Point-of-Care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study
BMJ Open Diabetes Research and Care
MetadataShow full item record
Barron, E., Misra, S., English, E., John, W., Sampson, M., Bachmann, M., Barth, J., et al. Experience of Point-of-Care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study. BMJ Open Diabetes Research and Care https://doi.org/10.17863/CAM.58675
Abstract Introduction To report the observations of point-of-care (POC) HbA1c testing in people with non-diabetic hyperglycaemia (NDH; HbA1c 42-47mmol/mol (6.0-6.4%)), applied in community settings, within the English National Health Service Diabetes Prevention Programme (NHS DPP). Research Design and Methods A service evaluation assessing prospectively collected national service-level data from the NHS DPP, using data from the first referral received in June 2016 to 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 programme using one of three POC devices; DCA Vantage, Afinion or A1C Now+. Differences between the referral and POC HbA1c and the standard deviation (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. Results Data from 73,703 participants demonstrated a significant mean difference between the referral and POC HbA1c of -2.48mmol/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 4.46mmol/mol (0.41%) with significant differences in SDs between devices (F(2, 73,700)=1,542, 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. Normoglycaemic POC HbA1c vs. NDH POC HbA1c values were associated with lower subsequent attendance at behavioural interventions (58% vs. 67%,p<0.001). Conclusions POC HbA1c testing in community settings was associated with significantly lower HbA1c values when compared to laboratory-measured referrals. Acknowledging effects of regression to the mean, these differences were also associated with POC method, location, individual patient-factors and time between measurements. Compared to POC HbA1c values in the NDH range, normoglycaemic POC HbA1c values were associated with lower subsequent intervention attendance.
SM is supported by a European Federation for the Study of Diabetes (EFSD) Mentorship Award. KK acknowledges support from National Institute for Health Research (NIHR) Applied Research Collaboration and the NIHR Leicester Biomedical Research Centre. SJ is funded by the NIHR Oxford Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research and Care Oxford.
Embargo Lift Date
This record's DOI: https://doi.org/10.17863/CAM.58675
This record's URL: https://www.repository.cam.ac.uk/handle/1810/311583
All rights reserved