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Published on: January 28, 2014
Dried Blood Spot Test for Glycated Hemoglobin Measurement in Pediatric Diabetes Care
Mallory McNiven1, Netusha Thevaranjan2, Daphne Yau2
1Department of Pediatrics, University of Saskatchewan, Regina, Saskatchewan, Canada.
Insights
Dried blood spot (DBS) cards offer a practical method for measuring glycated hemoglobin (A1C) in children with diabetes. This study validates DBS A1C testing, showing strong correlation with traditional methods, especially for lower A1C levels.
Area of Science:
- Pediatric Endocrinology
- Clinical Chemistry
- Diabetes Mellitus Diagnostics
Background:
- Dried blood spot (DBS) cards offer a novel, less invasive method for glycated hemoglobin (A1C) measurement compared to traditional phlebotomy.
- Potential benefits include reduced blood volume, decreased procedural pain, and self-collection feasibility.
- While validated in adults, pediatric data for DBS A1C testing is limited.
Purpose of the Study:
- To validate A1C measurement using DBS cards against venous blood samples in a pediatric population.
- To identify potential barriers to the clinical implementation of DBS A1C testing.
Main Methods:
- Simultaneous collection of venous and DBS A1C samples from 62 pediatric patients.
- Analysis of samples at a central laboratory.
- Correlation analysis and data rescaling to account for interassay differences between DBS and venous methods.
Main Results:
- Mean venous A1C was 7.49% and mean DBS A1C was 7.26% (0.23% difference).
- Strong positive correlation observed between DBS and venous A1C (r=0.86, p<0.001), strengthening at lower A1C values (A1C <7.5%, r=0.87, p<0.0001).
- Rescaled data showed an even stronger correlation (r=0.8935, p<0.0001).
Conclusions:
- DBS A1C testing demonstrates feasibility, practicality, and cost-effectiveness in pediatric diabetes care.
- The method shows particular promise for accuracy at A1C levels near the diabetes diagnostic threshold.
- Supports the consideration of DBS A1C testing for pediatric diabetes management and monitoring.
Background:
The dried blood spot (DBS) card is a novel collection method for measuring glycated hemoglobin (A1C) in individuals with diabetes mellitus. The potential benefits of DBS specimens compared with traditional phlebotomy include a reduction in required total blood volume, reduced procedural pain, and an ability for self-initiated collection. DBS cards for A1C measurement have been validated in the adult population, but there is a paucity of pediatric data.
Methods:
The aim of this study was to validate the use of A1C measurement by DBS cards in comparison to venous A1C and to identify potential barriers to implementing this novel approach. Venous and DBS card A1C samples were collected simultaneously from 62 patients at their local laboratory and transported to the central provincial lab for analysis. Correlation analyses compared venous and DBS A1C with data rescaling performed to account for the DBS-venous interassay difference.
Results:
Mean venous A1C was 7.49% and DBS A1C was 7.26%, with an interassay difference of 0.23%. Data showed a strong, positive correlation between A1C collection methods (r=0.86, p<0.001); this was further strengthened at lower A1C values (A1C <7.5%, r=0.87, p<0.0001). A stronger relationship emerged when the data were rescaled to account for the DBS-venous interassay difference (r=0.8935, p<0.0001).
Conclusions:
Given the potential feasibility, practicality, accessibility, cost-effectiveness, and performance characteristics of the DBS A1C, especially at lower A1C values hovering around the diagnostic threshold for diabetes, this study provides supporting evidence for consideration of the use of DBS A1C testing in pediatric diabetes care.
