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

Background: It is not clear if point-of-care (POC) testing for hemoglobin A(1c) (HbA(1c)) is associated with glycemic control in type 2 diabetes. Methods: In this cross-sectional study, we linked general practitioner (GP) data on 22,778 Norwegian type 2 diabetes patients to data from the Norwegian O...

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Veröffentlicht in:Clinical chemistry and laboratory medicine 2020-08, Vol.58 (8), p.1349-1356
Hauptverfasser: Tollanes, Mette C., Jenum, Anne K., Berg, Tore Julsrud, Lovaas, Karianne F., Cooper, John G., Sandberg, Sverre
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Sprache:eng
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Zusammenfassung:Background: It is not clear if point-of-care (POC) testing for hemoglobin A(1c) (HbA(1c)) is associated with glycemic control in type 2 diabetes. Methods: 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(1c) POC testing (average yearly "trueness score", 0-4), as well as frequency of participation in HbA(1c) external quality assurance (EQA) surveys, were associated with patients' HbA(1c) levels during 2014-2017. Results: Twenty-eight out of 393 GP offices (7%) did not perform HbA(1c) POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA(1c) 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(1c) EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA(1c) levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices' HbA(1c) POC analytical trueness score, the patients' HbA(1c) levels were lower by 0.04% HbA(1c) (-0.09, -0.001) (-0.5 mmol/mol [-1.0, -0.01]). Conclusions: Novel use of validated patient data in -combination with laboratory EQA data showed that patients consulting GPs in offices that perform HbA(1c) POC testing, participate in HbA(1c) EQA surveys, and maintain good analytical quality have lower HbA(1c) levels. Accurate HbA(1c) POC results, available during consultations, may improve diabetes care.
ISSN:1434-6621
1437-4331
DOI:10.1515/cclm-2020-0026