Home Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes
Article
Licensed
Unlicensed Requires Authentication

Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes

  • Mette C. Tollånes EMAIL logo , Anne K. Jenum , Tore Julsrud Berg , Karianne F. Løvaas , John G. Cooper and Sverre Sandberg
Published/Copyright: March 25, 2020
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 58 Issue 8

Abstract

Background

It is not clear if point-of-care (POC) testing for hemoglobin A1c (HbA1c) 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 HbA1c POC testing (average yearly “trueness score”, 0–4), as well as frequency of participation in HbA1c external quality assurance (EQA) surveys, were associated with patients’ HbA1c levels during 2014–2017.

Results

Twenty-eight out of 393 GP offices (7%) did not perform HbA1c POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA1c levels (95% confidence interval (0.04–0.27) (1.7 mmol/mol [0.5–2.9]). GP offices participating in one or two yearly HbA1c EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA1c levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices’ HbA1c POC analytical trueness score, the patients’ HbA1c levels were lower by 0.04% HbA1c (−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 HbA1c POC testing, participate in HbA1c EQA surveys, and maintain good analytical quality have lower HbA1c levels. Accurate HbA1c POC results, available during consultations, may improve diabetes care.

Keywords: glycemic control; hemoglobin A1c; point-of-care testing; primary care; type 2 diabetes
Corresponding author: Mette C. Tollånes, MD, PhD, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, P.O. Box 6165, N-5892 Bergen, Norway, Phone: +47 94498269, Fax: +47 55979510

  1. Author contributions: All 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 organizations played no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report; or in the decision to submit the report for publication.

References

1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837–53.10.1016/S0140-6736(98)07019-6Search in Google Scholar

2. Eeg-Olofsson K, Zethelius B, Gudbjornsdottir S, Eliasson B, Svensson AM, Cederholm J. Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: report from the Swedish National Diabetes Register. Diab Vasc Dis Res 2016;13:268–77.10.1177/1479164116637311Search in Google Scholar PubMed

3. St John A, Price CP. Point-of-care testing. In: Rifai N, Horvath AR, Wittwer CT, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 6th Ed. St. Louis, MO: Elsevier, 2018:371.Search in Google Scholar

4. Al-Ansary L, Farmer A, Hirst J, Roberts N, Glasziou P, Perera R, et al. Point-of-care testing for HbA1c in the management of diabetes: a systematic review and metaanalysis. Clin Chem 2011;57:568–76.10.1373/clinchem.2010.157586Search in Google Scholar PubMed

5. Schnell O, Crocker JB, Weng J. Impact of HbA1c testing at point of care on diabetes management. J Diabetes Sci Technol 2017;11:611–7.10.1177/1932296816678263Search in Google Scholar PubMed PubMed Central

6. Florkowski C, Don-Wauchope A, Gimenez N, Rodriguez-Capote K, Wils J, Zemlin A. Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) – does it leverage any advantage in clinical decision making? Crit Rev Clin Lab Sci 2017;54:471–94.10.1080/10408363.2017.1399336Search in Google Scholar PubMed

7. Kennedy L, Herman WH, Strange P, Harris A, Team GA. Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial. Diabetes Care 2006;29:1–8.10.2337/diacare.29.01.06.dc05-1058Search in Google Scholar PubMed

8. Khunti K, Stone MA, Burden AC, Turner D, Raymond NT, Burden M, et al. Randomised controlled trial of near-patient testing for glycated haemoglobin in people with type 2 diabetes mellitus. Br J Gen Pract 2006;56:511–7.Search in Google Scholar

9. Rust G, Gailor M, Daniels E, McMillan-Persaud B, Strothers H, Mayberry R. Point of care testing to improve glycemic control. Int J Health Care Qual Assur 2008;21:325–35.10.1108/09526860810868256Search in Google Scholar PubMed PubMed Central

10. Bubner TK, Laurence CO, Gialamas A, Yelland LN, Ryan P, Willson KJ, et al. Effectiveness of point-of-care testing for therapeutic control of chronic conditions: results from the PoCT in General Practice Trial. Med J Aust 2009;190:624–6.10.5694/j.1326-5377.2009.tb02590.xSearch in Google Scholar PubMed

11. Thaler LM, Ziemer DC, Gallina DL, Cook CB, Dunbar VG, Phillips LS, et al. Diabetes in urban African-Americans. XVII. Availability of rapid HbA1c measurements enhances clinical decision-making. Diabetes Care 1999;22:1415–21.10.2337/diacare.22.9.1415Search in Google Scholar PubMed

12. Motta LA, Shephard MD, Brink J, Lawson S, Rheeder P. Point-of-care testing improves diabetes management in a primary care clinic in South Africa. Prim Care Diabetes 2017;11:248–53.10.1016/j.pcd.2016.09.008Search in Google Scholar PubMed

13. Petersen JR, Finley JB, Okorodudu AO, Mohammad AA, Grady JJ, Bajaj M. Effect of point-of-care on maintenance of glycemic control as measured by A1C. Diabetes Care 2007;30:713–5.10.2337/dc06-1909Search in Google Scholar PubMed

14. Stavelin A, Sandberg S. Harmonization activities of Noklus – a quality improvement organization for point-of-care laboratory examinations. Clin Chem Lab Med 2018;57:106–14.10.1515/cclm-2018-0061Search in Google Scholar PubMed

15. Bukve T, Roraas T, Riksheim BO, Christensen NG, Sandberg S. Point-of-care urine albumin in general practice offices: effect of participation in an external quality assurance scheme. Clin Chem Lab Med 2015;53:45–51.10.1515/cclm-2014-0483Search in Google Scholar PubMed

16. Bukve T, Stavelin A, Sandberg S. Effect of participating in a quality improvement system over time for point-of-care C-reactive protein, glucose, and hemoglobin testing. Clin Chem 2016;62:1474–81.10.1373/clinchem.2016.259093Search in Google Scholar PubMed

17. Solvik UO, Roraas T, Christensen NG, Sandberg S. Diagnosing diabetes mellitus: performance of hemoglobin A1c point-of-care instruments in general practice offices. Clin Chem 2013;59:1790–801.10.1373/clinchem.2013.210781Search in Google Scholar PubMed

18. Cooper J, Thue G, Claudi T, Lovaas K, Carlsen S, Sandberg S. The Norwegian Diabetes Register for Adults – an overview of the first years. Norsk Epidemiologi 2013;23:6.10.5324/nje.v23i1.1599Search in Google Scholar

19. Bakke A, Cooper JG, Thue G, Skeie S, Carlsen S, Dalen I, et al. Type 2 diabetes in general practice in Norway 2005–2014: moderate improvements in risk factor control but still major gaps in complication screening. Br Med J Open Diabetes Res Care 2017;5:e000459.10.1136/bmjdrc-2017-000459Search in Google Scholar PubMed PubMed Central

20. Hirst JA, McLellan JH, Price CP, English E, Feakins BG, Stevens RJ, et al. Performance of point-of-care HbA1c test devices: implications for use in clinical practice – a systematic review and meta-analysis. Clin Chem Lab Med 2017;55:167–80.10.1515/cclm-2016-0303Search in Google Scholar PubMed

21. Rose G. Some implications of population changes. In: The strategy of preventive medicine. New York, USA: Oxford University Press, 1992:74.Search in Google Scholar

Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-0026).

Received: 2020-01-10
Accepted: 2020-02-17
Published Online: 2020-03-25
Published in Print: 2020-07-28

©2020 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Quality controls for serology: an unfinished agenda
  4. A modern and pragmatic definition of Laboratory Medicine
  5. Reviews
  6. Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and meta-analysis
  7. ISO/TS 20914:2019 – a critical commentary
  8. Mini Review
  9. Reporting of D-dimer data in COVID-19: some confusion and potential for misinformation
  10. Opinion Paper
  11. Implementation of metrological traceability in laboratory medicine: where we are and what is missing
  12. IFCC Recommendation
  13. Recommendation for performance verification of patient-based real-time quality control
  14. Genetics and Molecular Diagnostics
  15. Comparison of BCR-ABL1 quantification in peripheral blood and bone marrow using an International Scale-standardized assay for assessment of deep molecular response in chronic myeloid leukemia
  16. General Clinical Chemistry and Laboratory Medicine
  17. Risk assessment of the total testing process based on quality indicators with the Sigma metrics
  18. Determination of hemolysis cut-offs for biochemical and immunochemical analytes according to their value
  19. A computer model for professional competence assessment according to ISO 15189
  20. Traceability validation of six enzyme measurements on the Abbott Alinity c analytical system
  21. Evaluating the need for free glycerol blanking for serum triglyceride measurements at Charlotte Maxeke Johannesburg Academic Hospital
  22. Challenges of LC-MS/MS ethyl glucuronide analysis in abstinence monitoring of liver transplant candidates
  23. Changes in the result of antinuclear antibody immunofluorescence assay on HEp-2 cells reflect disease activity status in systemic lupus erythematosus
  24. Reference Values and Biological Variations
  25. Long-term biological variation estimates of 13 hematological parameters in healthy Chinese subjects
  26. Age-specific reference values improve the diagnostic performance of AMH in polycystic ovary syndrome
  27. Establishment of reference intervals for immunoassay analytes of adult population in Saudi Arabia
  28. Hematology and Coagulation
  29. Total haemoglobin – a reference measuring system for improvement of standardisation
  30. Laboratory testing for activated protein C resistance: rivaroxaban induced interference and a comparative evaluation of andexanet alfa and DOAC Stop to neutralise interference
  31. Cancer Diagnostics
  32. Identification of a four-gene methylation biomarker panel in high-grade serous ovarian carcinoma
  33. Performance comparison of two next-generation sequencing panels to detect actionable mutations in cell-free DNA in cancer patients
  34. Diabetes
  35. Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes
  36. Infectious Diseases
  37. Validation of a chemiluminescent assay for specific SARS-CoV-2 antibody
  38. Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019
  39. Does a change in quality control results influence the sensitivity of an anti-HCV test?
  40. Letters to the Editor
  41. Variability between testing methods for SARS-CoV-2 nucleic acid detection 16 days post-discharge: a case report
  42. L-index, more than a screening tool for hypertriglyceridemia
  43. Neutralization of biotin interference: preliminary evaluation of the VeraTest Biotin™, VeraPrep Biotin™ and BioT-Filter®
  44. Counting and reporting band count is unreliable practice due to the high inter-observer variability
  45. Cigarette smoking prior to blood sampling acutely affects serum levels of the chronic obstructive pulmonary disease biomarker surfactant protein D
  46. How reliable is the detection of anti-mitochondrial antibodies on murine triple-tissue?
  47. Further advices on measuring lipoprotein(a) for reducing the residual cardiovascular risk on statin therapy
https://doi.org/10.1515/cclm-2020-0026
Keywords for this article
glycemic control; hemoglobin A1c; point-of-care testing; primary care; type 2 diabetes

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Quality controls for serology: an unfinished agenda
  4. A modern and pragmatic definition of Laboratory Medicine
  5. Reviews
  6. Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and meta-analysis
  7. ISO/TS 20914:2019 – a critical commentary
  8. Mini Review
  9. Reporting of D-dimer data in COVID-19: some confusion and potential for misinformation
  10. Opinion Paper
  11. Implementation of metrological traceability in laboratory medicine: where we are and what is missing
  12. IFCC Recommendation
  13. Recommendation for performance verification of patient-based real-time quality control
  14. Genetics and Molecular Diagnostics
  15. Comparison of BCR-ABL1 quantification in peripheral blood and bone marrow using an International Scale-standardized assay for assessment of deep molecular response in chronic myeloid leukemia
  16. General Clinical Chemistry and Laboratory Medicine
  17. Risk assessment of the total testing process based on quality indicators with the Sigma metrics
  18. Determination of hemolysis cut-offs for biochemical and immunochemical analytes according to their value
  19. A computer model for professional competence assessment according to ISO 15189
  20. Traceability validation of six enzyme measurements on the Abbott Alinity c analytical system
  21. Evaluating the need for free glycerol blanking for serum triglyceride measurements at Charlotte Maxeke Johannesburg Academic Hospital
  22. Challenges of LC-MS/MS ethyl glucuronide analysis in abstinence monitoring of liver transplant candidates
  23. Changes in the result of antinuclear antibody immunofluorescence assay on HEp-2 cells reflect disease activity status in systemic lupus erythematosus
  24. Reference Values and Biological Variations
  25. Long-term biological variation estimates of 13 hematological parameters in healthy Chinese subjects
  26. Age-specific reference values improve the diagnostic performance of AMH in polycystic ovary syndrome
  27. Establishment of reference intervals for immunoassay analytes of adult population in Saudi Arabia
  28. Hematology and Coagulation
  29. Total haemoglobin – a reference measuring system for improvement of standardisation
  30. Laboratory testing for activated protein C resistance: rivaroxaban induced interference and a comparative evaluation of andexanet alfa and DOAC Stop to neutralise interference
  31. Cancer Diagnostics
  32. Identification of a four-gene methylation biomarker panel in high-grade serous ovarian carcinoma
  33. Performance comparison of two next-generation sequencing panels to detect actionable mutations in cell-free DNA in cancer patients
  34. Diabetes
  35. Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes
  36. Infectious Diseases
  37. Validation of a chemiluminescent assay for specific SARS-CoV-2 antibody
  38. Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019
  39. Does a change in quality control results influence the sensitivity of an anti-HCV test?
  40. Letters to the Editor
  41. Variability between testing methods for SARS-CoV-2 nucleic acid detection 16 days post-discharge: a case report
  42. L-index, more than a screening tool for hypertriglyceridemia
  43. Neutralization of biotin interference: preliminary evaluation of the VeraTest Biotin™, VeraPrep Biotin™ and BioT-Filter®
  44. Counting and reporting band count is unreliable practice due to the high inter-observer variability
  45. Cigarette smoking prior to blood sampling acutely affects serum levels of the chronic obstructive pulmonary disease biomarker surfactant protein D
  46. How reliable is the detection of anti-mitochondrial antibodies on murine triple-tissue?
  47. Further advices on measuring lipoprotein(a) for reducing the residual cardiovascular risk on statin therapy
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 26.10.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2020-0026/html
Scroll to top button