TY - JOUR
T1 - Point-of-care testing for Hb A1c in the management of diabetes
T2 - A systematic review and metaanalysis
AU - Al-Ansary, Lubna
AU - Farmer, Andrew
AU - Hirst, Jennifer
AU - Roberts, Nia
AU - Glasziou, Paul
AU - Perera, Rafael
AU - Price, Christopher P.
PY - 2011/4
Y1 - 2011/4
N2 - BACKGROUND: The measurement of hemoglobin A1c (Hb A 1c) is employed in monitoring of patients with diabetes. Use of point-of-care testing (POCT) for Hb A1c results at the time of the patient consultation potentially provides an opportunity for greater interaction between patient and caregiver, and more effective care. OBJECTIVE: To perform a systematic review of current trials to determine whether POCT for Hb A 1c, compared with conventional laboratory testing, improves outcomes for patients with diabetes. METHODS: Searches were undertaken on 4 electronic databases and bibliographies from, and hand searches of, relevant journal papers. Only randomized controlled trials were included. The primary outcome measures were change in Hb A1c and treatment intensification. Metaanalyses were performed on the data obtained. RESULTS: Seven trials were found. There was a nonsignificant reduction of 0.09% (95% CI -0.21 to 0.02) in the Hb A1c in the POCT compared to the standard group. Although data were collected on the change in proportion of patients reaching a target Hb A1c of <7.0%, treatment intensification and heterogeneity in the populations studied and how measures were reported precluded pooling of data and metaanalysis. Positive patient satisfaction was also reported in the studies, as well as limited assessments of costs. CONCLUSIONS: There is an absence of evidence in clinical trial data to date for the effectiveness of POCT for Hb A1c in the management of diabetes. In future studies attention to trial design is needed to ensure appropriate selection and stratification of patients, collection of outcome measures, and action taken upon Hb A 1c results when produced.
AB - BACKGROUND: The measurement of hemoglobin A1c (Hb A 1c) is employed in monitoring of patients with diabetes. Use of point-of-care testing (POCT) for Hb A1c results at the time of the patient consultation potentially provides an opportunity for greater interaction between patient and caregiver, and more effective care. OBJECTIVE: To perform a systematic review of current trials to determine whether POCT for Hb A 1c, compared with conventional laboratory testing, improves outcomes for patients with diabetes. METHODS: Searches were undertaken on 4 electronic databases and bibliographies from, and hand searches of, relevant journal papers. Only randomized controlled trials were included. The primary outcome measures were change in Hb A1c and treatment intensification. Metaanalyses were performed on the data obtained. RESULTS: Seven trials were found. There was a nonsignificant reduction of 0.09% (95% CI -0.21 to 0.02) in the Hb A1c in the POCT compared to the standard group. Although data were collected on the change in proportion of patients reaching a target Hb A1c of <7.0%, treatment intensification and heterogeneity in the populations studied and how measures were reported precluded pooling of data and metaanalysis. Positive patient satisfaction was also reported in the studies, as well as limited assessments of costs. CONCLUSIONS: There is an absence of evidence in clinical trial data to date for the effectiveness of POCT for Hb A1c in the management of diabetes. In future studies attention to trial design is needed to ensure appropriate selection and stratification of patients, collection of outcome measures, and action taken upon Hb A 1c results when produced.
UR - http://www.scopus.com/inward/record.url?scp=79956096361&partnerID=8YFLogxK
U2 - 10.1373/clinchem.2010.157586
DO - 10.1373/clinchem.2010.157586
M3 - Article
C2 - 21368238
AN - SCOPUS:79956096361
SN - 0009-9147
VL - 57
SP - 568
EP - 576
JO - Clinical Chemistry
JF - Clinical Chemistry
IS - 4
ER -
