Home Volumetric absorptive microsampling at home as an alternative tool for the monitoring of HbA1c in diabetes patients
Article
Licensed
Unlicensed Requires Authentication

Volumetric absorptive microsampling at home as an alternative tool for the monitoring of HbA1c in diabetes patients

  • Nick Verougstraete , Bruno Lapauw , Sara Van Aken , Joris Delanghe , Christophe Stove and Veronique Stove EMAIL logo
Published/Copyright: October 12, 2016
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 55 Issue 3

Abstract

Background:

Microsampling techniques have several advantages over traditional blood collection. Dried blood spot (DBS) sampling and blood collection with heparinized capillaries are the standard techniques. Volumetric absorptive microsampling (VAMS) is a novel technique that collects a fixed volume of blood by applying an absorbent tip to a blood drop. In the present study we explored the feasibility of HbA1c monitoring with VAMS sampling at home and analysis in the laboratory.

Methods:

Diabetic patients were enrolled in this study during consultation with the endocrinologist. A venous (adults) or capillary (children) sample was taken for immediate HbA1c analysis. DBS (n=1) and dried VAMS (n=2) were collected at home and sent to the laboratory. For 25 pediatric patients one VAMS was collected during consultation for immediate analysis (without drying), referred to as “wet VAMS”. HbA1c analyses were performed on a Tosoh HLC-723 G8 high-performance liquid chromatography (HPLC) analyzer.

Results:

The median time between sampling at home and analysis was 3 days. Results of HbA1c in dried VAMS showed a poor agreement with venous/capillary blood collected in hospital (concordance correlation coefficient CCC=0.72). Similar observations were found with standard DBS. An excellent agreement was obtained between HbA1c results on wet VAMS (CCC=0.996) and standard blood samples. Patients experienced VAMS and DBS as easy and convenient to use.

Conclusions:

Utilizing equipment standard available in the clinical laboratory, the use of home-sampled dried VAMS and DBS is not a reliable tool for the monitoring of HbA1c. However, perfect agreement between HbA1c measured on wet VAMS and capillary microsamples was obtained.

Keywords: diabetes; dried blood spots; hemoglobin A1c; home-sampling; volumetric absorptive microsampling

Acknowledgments

We thank Silvi Van Loon and Evelien Bauwens for the coordination of this study in the laboratory. We also thank the volunteers for their participation in the study.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. American Diabetes Association. Standards of medical care in diabetes – 2014. Diabetes Care 2014;37(Suppl 1):S14–80.10.2337/dc14-S014Search in Google Scholar PubMed

2. Stratton IM, Adler AI, Matthews DR, Manley SE, Cull CA, Hadden D, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J 2000;321:405–12.10.1136/bmj.321.7258.405Search in Google Scholar PubMed PubMed Central

3. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53.10.2337/diacare.27.10.2569-aSearch in Google Scholar

4. Heylen O, Van Neyghem S, Exterbille S, Wehlou C, Gorus F, Weets I. Evaluation of the Sebia Capillarys 2 flex piercing for the measurement of HbA(1c) on venous and capillary blood samples. Am J Clin Pathol 2014;141:867–77.10.1309/AJCPRU5QC2JBANSVSearch in Google Scholar PubMed

5. Voss EM, Cembrowski GS, Clasen BL, Spencer ML, Ainslie MB, Haig B. Evaluation of capillary collection system for HbA1c specimens. Diabetes Care 1992;15:700–1.10.2337/diacare.15.5.700Search in Google Scholar PubMed

6. Godefroid MJ, De Buyzere ML, Delanghe JR. Interchangeability of venous and capillary HbA(1c) results is affected by oxidative stress. Clin Chem Lab Med 2013;51:9–11.10.1515/cclm-2012-0312Search in Google Scholar PubMed

7. Affan ET, Praveen D, Chow CK, Neal BC. Comparability of HbA1c and lipids measured with dried blood spot versus venous samples: a systematic review and meta-analysis. BMC Clin Pathol 2014;14:21.10.1186/1472-6890-14-21Search in Google Scholar PubMed PubMed Central

8. Anjali S, Geethanjali FS, Kumar RS, Seshadri MS. Accuracy of filter paper method for measuring glycated hemoglobin. J Assoc Physicians India 2007;55:115–9.Search in Google Scholar

9. Egier DA, Keys JL, Hall SK, McQueen MJ. Measurement of hemoglobin A1c from filter papers for population-based studies. Clin Chem Lab Med 2011;57:577–85.10.1373/clinchem.2010.156380Search in Google Scholar PubMed

10. Jeppsson JO, Jerntorp P, Almër LO, Persson R, Ekberg G, Sundkvist G. Capillary blood on filter paper for determination of HbA1c by ion exchange chromatography. Diabetes Care 1996;2:142–5.10.2337/diacare.19.2.142Search in Google Scholar PubMed

11. Jones TG, Warber KD, Roberts BD. Analysis of hemoglobin A1c from dried blood spot samples with the Tina-quantR II immunoturbidimetric method. J Diabetes Sci Technol 2010;4:244–9.10.1177/193229681000400203Search in Google Scholar PubMed PubMed Central

12. Lakshmy R, Gupta R. Measurement of glycated hemoglobin A1c from dried blood by turbidimetric immunoassay. J Diabetes Sci Technol 2009;3:1203–6.10.1177/193229680900300527Search in Google Scholar

13. Little RR, McKenzie EM, Wiedmeyer HM, England JD, Goldstein DE. Collection of blood on filter paper for measurement of glycated hemoglobin by affinity chromatography. Clin Chem Lab Med 1986;32:869–71.10.1093/clinchem/32.5.869Search in Google Scholar

14. Tabatabaei-Malazy O, Heshmat R, Omidfar K, Pasalar P, Delavari A, Keshtkar A, et al. Glycated hemoglobin measurements from dried blood spots: reliability and relation to results obtained from whole blood samples. J Diabetes Metab Disord 2011;10:1–6.Search in Google Scholar

15. Wikblad K, Smide B, Bergström A, Wahren L, Mugusi F, Jeppsson JO. Immediate assessment of HbA1c under field conditions in Tanzania. Diabetes Res Clin Pract 1998;40:123–8.10.1016/S0168-8227(98)00046-1Search in Google Scholar

16. Lacher DA, Berman LE, Chen TC, Porter KS. Comparison of dried blood spot to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein. Clin Chim Acta 2013;422:54–8.10.1016/j.cca.2013.03.032Search in Google Scholar PubMed

17. Miller IM, Lacher DA, Chen TC, Zipf GW, Gindi RM, Galinksy AM, et al. Collection and laboratory methods for dried blood spots for hemoglobin A1c and total and high-density lipoprotein cholesterol in population-based-surveys. Clin Chim Acta 2015;445:143–54.10.1016/j.cca.2015.03.028Search in Google Scholar PubMed PubMed Central

18. Mastronardi CA, Whittle B, Tunningley R, Neeman T, Paz-Filho G. The use of dried blood spot sampling for the measurement of HbA1c: a cross-sectional study. BMC Clin Pathol 2015;15:13.10.1186/s12907-015-0013-5Search in Google Scholar PubMed PubMed Central

19. Fokkema MR, Bakker AJ, de Boer F, Kooistra J, de Vries S, Wolthuis A. HbA1c measurements from dried blood spots: validation and patient satisfaction. Clin Chem Lab Med 2009;47:1259–64.10.1515/CCLM.2009.274Search in Google Scholar PubMed

20. De Kesel PM, Sadones N, Capiau S, Lambert WE, Stove CP. Hemato-critical issues in quantitative analysis of dried blood spots: challenges and solutions. Bioanalysis 2013;5:2023–41.10.4155/bio.13.156Search in Google Scholar PubMed

21. De Kesel PM, Lambert WE, Stove CP. Why dried blood spots are an ideal tool for CYP1A2 phenotyping. Clin Pharmacokinet 2014;53:763–71.10.1007/s40262-014-0150-5Search in Google Scholar PubMed

22. Velghe S, Capiau S, Stove CP. Opening the toolbox of alternative sampling strategies in clinical routine: a key-role for (LC-)MS/MS. Trends Analyt Chem 2016; doi: 10.1016/j.trac.2016.01.030. [Epub ahead of print].Search in Google Scholar

23. Denniff P, Spooner N. Volumetric absorptive microsampling: a dried sample collection technique for quantitative bioanalysis. Anal Chem 2014;86:8489–95.10.1021/ac5022562Search in Google Scholar PubMed

24. Spooner N, Denniff P, Michielsen L, De Vries R, Ji QC, Arnold ME, et al. A device for dried blood microsampling in quantitative bioanalysis: overcoming the issues associated blood hematocrit. Bioanalysis 2015;7:653–9.10.4155/bio.14.310Search in Google Scholar PubMed

25. De Kesel PM, Lambert WE, Stove CP. Does volumetric absorptive microsampling eliminate the hematocrit bias for caffeine and paraxanthine in dried blood samples? A comparative study. Anal Chim Acta 2015;881:65–73.10.1016/j.aca.2015.04.056Search in Google Scholar PubMed

26. Wilhelm AJ, den Burger JC, Swart EL. Therapeutic drug monitoring by dried blood spot: progress to date and future directions. Clin Pharmacokinet 2014;53:961–73.10.1007/s40262-014-0177-7Search in Google Scholar PubMed PubMed Central

27. Royal College of Pathologists of Australasia. RCPA quality requirements. https://www.westgard.com/rcpa.htm. Accessed: 27 Feb 2016.Search in Google Scholar

28. Weykamp CW, Mosca A, Gillery P, Panteghini M. The analytical goals for hemoglobin A1c measurement in IFCC units and National Glycohemoglobin Standardization Program units are different [Letter]. Clin Chem Lab Med 2011;57:1204–6.Search in Google Scholar

29. McBride GB. A proposal for strength-of-agreement criteria for Lin’s Concordance Correlation Coefficient. NIWA Client Report 2005;HAM2005-062.Search in Google Scholar

30. Capiau S, Wilk LS, Aalders MC, Stove CP. A novel, nondestructive, dried blood spot-based hematocrit prediction method using noncontact diffuse reflectance spectroscopy. Anal Chem 2016;88:6538–46.10.1021/acs.analchem.6b01321Search in Google Scholar PubMed

31. Jeppsson JO, Kobold U, Barr J, Finke A, Hoelzel W, Hoshino T, et al. Approved IFCC reference method for the measurement of HbA1c in human blood. Clin Chem Lab Med 2002;40:78–89.10.1515/CCLM.2002.016Search in Google Scholar PubMed

32. Westgard QC. Desirable biological variation database specifications. https://www.westgard.com/biodatabase1.htm. Accessed: 13 Mar 2016.Search in Google Scholar

33. Bendavid C, Peltier L, Letellier C. Capillary blood sampling kit for HbA1c versus venous puncture on Capillarys 2 flex piercing. Clin Chem Lab Med 2015;53:(Suppl):S655.Search in Google Scholar

Supplemental Material:

The online version of this article (DOI: 10.1515/cclm-2016-0411) offers supplementary material, available to authorized users.

Received: 2016-5-12
Accepted: 2016-9-8
Published Online: 2016-10-12
Published in Print: 2017-3-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Targeting errors in microbiology: the case of the Gram stain
  4. Time for a holistic approach and standardization education in laboratory medicine
  5. Reviews
  6. Serum uric acid levels and risk of prehypertension: a meta-analysis
  7. Lactic acidosis: an update
  8. Mini Review
  9. Progress and impact of enzyme measurement standardization
  10. Opinion Paper
  11. Critical comments to a recent EFLM recommendation for the review of reference intervals
  12. IFCC Paper
  13. Quality Indicators in Laboratory Medicine: the status of the progress of IFCC Working Group “Laboratory Errors and Patient Safety” project
  14. Genetics and Molecular Diagnostics
  15. Evaluation and comparison of three assays for molecular detection of spinal muscular atrophy
  16. General Clinical Chemistry and Laboratory Medicine
  17. Risk analysis of the preanalytical process based on quality indicators data
  18. Analytical and clinical validation of the new Abbot Architect 25(OH)D assay: fit for purpose?
  19. Looking beyond linear regression and Bland-Altman plots: a comparison of the clinical performance of 25-hydroxyvitamin D tests
  20. Next-generation osmotic gradient ektacytometry for the diagnosis of hereditary spherocytosis: interlaboratory method validation and experience
  21. Diagnosis of sphingolipidoses: a new simultaneous measurement of lysosphingolipids by LC-MS/MS
  22. Monitoring nicotine intake from e-cigarettes: measurement of parent drug and metabolites in oral fluid and plasma
  23. Development of a rapid and quantitative lateral flow assay for the simultaneous measurement of serum κ and λ immunoglobulin free light chains (FLC): inception of a new near-patient FLC screening tool
  24. A real-world evidence-based approach to laboratory reorganization using e-Valuate benchmarking data
  25. Cancer Diagnostics
  26. Utility of proGRP as a tumor marker in the medullary thyroid carcinoma
  27. Cardiovascular Diseases
  28. Can non-cholesterol sterols and lipoprotein subclasses distribution predict different patterns of cholesterol metabolism and statin therapy response?
  29. Infectious Diseases
  30. Improving Gram stain proficiency in hospital and satellite laboratories that do not have microbiology
  31. Diabetes
  32. Volumetric absorptive microsampling at home as an alternative tool for the monitoring of HbA1c in diabetes patients
  33. Corrigendum
  34. EFLM Recommendation
  35. Corrigendum to: Recommendation for the review of biological reference intervals in medical laboratories
  36. Letters to the Editor
  37. Evaluation of the trueness of serum alkaline phosphatase measurement in a group of Italian laboratories
  38. Innovative software for recording preanalytical errors in accord with the IFCC quality indicators
  39. Mixing studies for abnormal coagulation screen – the current trend
  40. Identification of 5-fluorocytosine as a new interfering compound in serum capillary zone electrophoresis
  41. How to define reference intervals to rule in healthy individuals for clinical trials?
  42. Evaluation of the performance of INDEXOR® in the archive unit of a clinical laboratory: a step to Lean laboratory
  43. Evaluation of an automated chemiluminescent immunoassay for salivary cortisol measurement. Utility in the diagnosis of Cushing’s syndrome
  44. Analysis of hemolysis, icterus and lipemia in arterial blood gas specimens
  45. Comparison of three routine insulin immunoassays: implications for assessment of insulin sensitivity and response
https://doi.org/10.1515/cclm-2016-0411
Keywords for this article
diabetes; dried blood spots; hemoglobin A1c; home-sampling; volumetric absorptive microsampling

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Targeting errors in microbiology: the case of the Gram stain
  4. Time for a holistic approach and standardization education in laboratory medicine
  5. Reviews
  6. Serum uric acid levels and risk of prehypertension: a meta-analysis
  7. Lactic acidosis: an update
  8. Mini Review
  9. Progress and impact of enzyme measurement standardization
  10. Opinion Paper
  11. Critical comments to a recent EFLM recommendation for the review of reference intervals
  12. IFCC Paper
  13. Quality Indicators in Laboratory Medicine: the status of the progress of IFCC Working Group “Laboratory Errors and Patient Safety” project
  14. Genetics and Molecular Diagnostics
  15. Evaluation and comparison of three assays for molecular detection of spinal muscular atrophy
  16. General Clinical Chemistry and Laboratory Medicine
  17. Risk analysis of the preanalytical process based on quality indicators data
  18. Analytical and clinical validation of the new Abbot Architect 25(OH)D assay: fit for purpose?
  19. Looking beyond linear regression and Bland-Altman plots: a comparison of the clinical performance of 25-hydroxyvitamin D tests
  20. Next-generation osmotic gradient ektacytometry for the diagnosis of hereditary spherocytosis: interlaboratory method validation and experience
  21. Diagnosis of sphingolipidoses: a new simultaneous measurement of lysosphingolipids by LC-MS/MS
  22. Monitoring nicotine intake from e-cigarettes: measurement of parent drug and metabolites in oral fluid and plasma
  23. Development of a rapid and quantitative lateral flow assay for the simultaneous measurement of serum κ and λ immunoglobulin free light chains (FLC): inception of a new near-patient FLC screening tool
  24. A real-world evidence-based approach to laboratory reorganization using e-Valuate benchmarking data
  25. Cancer Diagnostics
  26. Utility of proGRP as a tumor marker in the medullary thyroid carcinoma
  27. Cardiovascular Diseases
  28. Can non-cholesterol sterols and lipoprotein subclasses distribution predict different patterns of cholesterol metabolism and statin therapy response?
  29. Infectious Diseases
  30. Improving Gram stain proficiency in hospital and satellite laboratories that do not have microbiology
  31. Diabetes
  32. Volumetric absorptive microsampling at home as an alternative tool for the monitoring of HbA1c in diabetes patients
  33. Corrigendum
  34. EFLM Recommendation
  35. Corrigendum to: Recommendation for the review of biological reference intervals in medical laboratories
  36. Letters to the Editor
  37. Evaluation of the trueness of serum alkaline phosphatase measurement in a group of Italian laboratories
  38. Innovative software for recording preanalytical errors in accord with the IFCC quality indicators
  39. Mixing studies for abnormal coagulation screen – the current trend
  40. Identification of 5-fluorocytosine as a new interfering compound in serum capillary zone electrophoresis
  41. How to define reference intervals to rule in healthy individuals for clinical trials?
  42. Evaluation of the performance of INDEXOR® in the archive unit of a clinical laboratory: a step to Lean laboratory
  43. Evaluation of an automated chemiluminescent immunoassay for salivary cortisol measurement. Utility in the diagnosis of Cushing’s syndrome
  44. Analysis of hemolysis, icterus and lipemia in arterial blood gas specimens
  45. Comparison of three routine insulin immunoassays: implications for assessment of insulin sensitivity and response
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 9.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2016-0411/html
Scroll to top button