Point-of-Care A1C and Time from Test to Communication of Results in Primary Care

Although patients with uncontrolled diabetes (A1C ≥ 9%) frequently visit their primary care physicians' offices, their diabetes medication is not always changed or intensified at those visits, a pattern described as "therapeutic inertia." One potential solution is the use of point-of-care fingerstick hemoglobin A1C (A1C), which provides results in minutes, rather than venous A1C, which takes days. However, point-of-care A1C is not consistently used in current practice. The authors sought to determine the effectiveness of a systematic nurse-based intervention for implementing point-of-care A1C testing among patients with uncontrolled diabetes. They conducted a before-and-after experimental trial to determine the effect of point-of-care A1C testing on therapeutic inertia in a hospital-based clinic in New York, NY, in 2024-2025. They compared the frequency of any clinical action taken and the time to communication of results to patients before vs. after intervention implementation, using chi-squared and t-tests, respectively. The study included 203 patients, of whom 40.4% were Black or African American and 38.9% were Hispanic. Systematic collection of point-of-care A1C did not change the frequency of clinical actions taken overall (79.0% pre-intervention vs. 73.8% post-intervention, P = 0.38). However, the intervention resulted in a significantly shorter time from test to communication of results to patients, compared to usual care (0.6 days vs. 7.4 days, P = 0.03). A systematic intervention to increase the utilization of point-of-care A1C is effective in facilitating faster delivery of results to patients, which enables more counseling for patients with uncontrolled diabetes during their visit.