Point-of-care testing for Hb A1c in the management of diabetes: A systematic review and metaanalysis

Lubna Al-Ansary, Andrew Farmer, Jennifer Hirst, Nia Roberts, Paul Glasziou, Rafael Perera, Christopher P. Price

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Abstract

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.

Original languageEnglish
Pages (from-to)568-576
Number of pages9
JournalClinical Chemistry
Volume57
Issue number4
DOIs
Publication statusPublished - Apr 2011

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Medical problems
Hemoglobins
Testing
Outcome Assessment (Health Care)
Bibliography
Physiologic Monitoring
Population Characteristics
Patient Satisfaction
Patient Selection
Caregivers
Bibliographies
Meta-Analysis
Referral and Consultation
Randomized Controlled Trials
Clinical Trials
Databases
Costs and Cost Analysis
Point-of-Care Testing
Therapeutics
Monitoring

Cite this

Al-Ansary, Lubna ; Farmer, Andrew ; Hirst, Jennifer ; Roberts, Nia ; Glasziou, Paul ; Perera, Rafael ; Price, Christopher P. / Point-of-care testing for Hb A1c in the management of diabetes : A systematic review and metaanalysis. In: Clinical Chemistry. 2011 ; Vol. 57, No. 4. pp. 568-576.
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abstract = "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.",
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Point-of-care testing for Hb A1c in the management of diabetes : A systematic review and metaanalysis. / Al-Ansary, Lubna; Farmer, Andrew; Hirst, Jennifer; Roberts, Nia; Glasziou, Paul; Perera, Rafael; Price, Christopher P.

In: Clinical Chemistry, Vol. 57, No. 4, 04.2011, p. 568-576.

Research output: Contribution to journalArticleResearchpeer-review

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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

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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.

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JO - Clinical Chemistry

JF - Clinical Chemistry

SN - 0009-9147

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