Point-of-care testing of HbA_1c and blood glucose in a remote Aboriginal Australian community

Authors

David D. Martin
Mark D S Shephard
Hayley Freeman
Max K. Bulsara, University of Notre Dame AustraliaFollow
Timothy W. Jones
Elizabeth A. Davis
Graeme P. Maguire

Publication Details

Martin, D. D., Shephard, M. D. S., Freeman, H., Bulsara, M. K., Jones, T. W., et al. (2005). Point-of-care testing of HbA_1c and blood glucose in a remote Aboriginal Australian community. Medical Journal of Australia, 182(10), 524-527.

Abstract

Objectives: To assess the accuracy of point-of-care (POC) measurements of capillary blood glucose and glycosylated haemoglobin (HbA_1c) levels in a remote Aboriginal community with high diabetes prevalence.

Design: Cross-sectional study comparing POC capillary glucose and HbA_1c results with those from corresponding venous samples measured in a reference laboratory.

Participants and setting: 152 residents aged 11–76 years (representing 76% of population aged over 11 years) had POC glucose measurement in November 2003; 88 with POC glucose level ≥ 5.0 mmol/L, or self-reported diabetes, had POC HbA_1c and laboratory glucose and HbA_1c measurements.

Main outcome measures: POC fasting capillary levels of glucose (HemoCue Glucose 201 analyser, Medipac Scientific, Sydney) and HbA_1c (DCA 2000+ analyser, Bayer Australia, Melbourne); correlation and mean difference between capillary POC and venous blood laboratory measurements of glucose and HbA_1c.

Results: Mean and median POC capillary glucose levels were 7.99 mmol/L and 6.25 mmol/L, respectively, while mean and median laboratory venous plasma glucose concentrations were 7.63 mmol/L and 5.35 mmol/L. Values for POC capillary HbA_1c and laboratory HbA1c were identical: mean, 7.06%; and median, 6.0%. The correlation coefficient r for POC and laboratory results was 0.98 for glucose and 0.99 for HbA_1c. The mean difference in results was 0.36 mmol/L for glucose (95% CI, 0.13–0.62; limits of agreement [LOA], − 2.07 to 2.79 mmol/L; P = 0.007) and < 0.01% for HbA_1c (95% CI, − 0.07% to 0.07%; LOA, − 0.66% to 0.66%; P = 0.95), respectively.

Conclusions: POC capillary HbA_1c testing, in particular, offers an accurate, practical, community-friendly way of monitoring diabetes in rural and remote clinical settings. POC capillary glucose results should be confirmed by a laboratory test of venous plasma if the results are likely to significantly influence clinical decisions.

Keywords

peer-reviewed