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Variation between Point-of-care and Laboratory HbA1c testing in Clinical Practice.
Shawn E Fellows1, Gabriela C Cipriano2
1Assistant Professor, Department of Pharmacy Practice Wegmans School of Pharmacy at St. John Fisher College, Rochester, NY.
Puerto Rico Health Sciences Journal
|September 20, 2019
Summary
Point-of-care hemoglobin A1c (HbA1c) testing may show disparities compared to laboratory results. Rely on self-monitoring and symptoms, not just POCT HbA1c, for diabetes diagnosis and therapy guidance.
Area of Science:
- Clinical Chemistry
- Point-of-Care Testing
- Diabetes Diagnostics
Background:
- Hemoglobin A1c (HbA1c) is crucial for diabetes management.
- Point-of-care testing (POCT) offers rapid results but requires validation against laboratory standards.
- Federally Qualified Health Centers (FQHCs) often utilize POCT for accessibility.
Purpose of the Study:
- To investigate discrepancies between POCT and laboratory HbA1c measurements.
- To assess the reliability of POCT HbA1c reporting within an FQHC setting.
Main Methods:
- Retrospective review of electronic medical records at an FQHC.
- Comparison of same-day POCT HbA1c and centralized laboratory venous HbA1c results.
- Manual data extraction to identify potential confounding variables.
Main Results:
- Analysis of 42 samples from 40 patients revealed a median HbA1c difference of 1.5 mmol/mol (0.15%).
- Observed HbA1c differences ranged significantly, from -26 to 52 mmol/mol (-2.4% to 4.8%).
- Two patients with comorbidities showed potential impact on POCT HbA1c accuracy.
Conclusions:
- POCT HbA1c should not be used as the sole method for diagnosing pre-diabetes and diabetes.
- Clinical decisions based on HbA1c require correlation with self-monitoring of blood glucose and patient symptoms (hypo- and hyperglycemia).
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