Point-of-care testing improves diabetes management in a primary care clinic in South Africa

Prim Care Diabetes. 2017 Jun;11(3):248-253. doi: 10.1016/j.pcd.2016.09.008. Epub 2017 Feb 1.

Abstract

Introduction: Diabetes is a major health problem in South Africa. DiabCare Africa found just 47% of diabetes patients had a hemoglobin A1c (HbA1c) test for their management in the previous year.

Methods: Patients attending an urban diabetes clinic near Johannesburg, run by Project HOPE, accessed HbA1c (and urine albumin:creatinine ratio) point-of-care testing (POCT) as part of a quality-assured international program called ACE (Analytical and Clinical Excellence). Patients who had two or more HbA1c POC tests from 2012 to 2014 were assessed to determine their change in glycaemic control.

Results: The mean (±SD) HbA1c in this group of diabetes patients (n=131) fell significantly from 9.7%±2.4 (83mmol/mol) at their first POCT measurement to 8.4%±2.4 (68mmol/mmol/mol) at their most recent POCT measurement (paired t-test p<0.01). The average time between first and most recent HbA1c test was 15 months. The number of diabetes patients achieving optimal glycaemic control (HbA1c≤6.5-7.5% [48-58mmol/mol) increased by 125%, while the number with very poor glycaemic control (HbA1c>10% [86mmol/mol]) halved. An association was observed between degree of glycaemic control and increasing albuminuria in this cohort.

Discussion: POCT has promoted change in clinical practice by facilitating greater accessibility to HbA1c testing.

Keywords: Diabetes mellitus; Global health; Point-of-care systems; Primary health care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Albumins / analysis
  • Albuminuria / diagnosis
  • Albuminuria / urine
  • Ambulatory Care Facilities*
  • Biomarkers / blood
  • Biomarkers / urine
  • Blood Chemical Analysis
  • Blood Glucose / metabolism*
  • Creatinine / urine
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / therapy
  • Female
  • Glycated Hemoglobin A / analysis*
  • Health Services Accessibility
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Systems* / standards
  • Point-of-Care Testing* / standards
  • Predictive Value of Tests
  • Primary Health Care*
  • Prognosis
  • Quality Improvement
  • Quality Indicators, Health Care
  • Reproducibility of Results
  • South Africa
  • Time Factors
  • Urinalysis

Substances

  • Albumins
  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Creatinine