Point-of-Care testing of HbA1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM Primary Care Diabetes Pub Date : 2024-02-01 DOI:10.1016/j.pcd.2023.10.011

Anna Gourlay , Calum Sutherland , Andrew Radley

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Abstract

Background

Glycated haemoglobin (HbA1c) measurement using Point of Care (POC) testing may be of huge utility, providing convenient testing for early diagnosis and regular monitoring of hard-to-reach patient groups. This systematic review aimed to identify evidence for the successful deployment of these devices to improve patient outcomes in diabetes.

Methods

A systematic review and meta-analysis was undertaken in February 2023, to identify all relevant articles: (CINAHL, Cochrane, PubMed, Scopus, and Web of Science). Studies were included if they reported outcomes of community POC testing for HbA1c for people with diabetes or at risk of diabetes. The Prospero database and trial registers were searched. Only English language articles were included.

Title, abstract screening and full text review was carried out by two reviewers (AG/AR). The Cochrane risk of bias tool for randomised studies and the NIH Quality Assessment tool for observational cohort and cross-sectional studies were used. Publication bias was assessed visually using funnel plot and statistical assessment. We performed a meta-analysis on appropriate studies, applying a fixed effect model. We investigated heterogeneity using visual inspection of forest plots along with evaluative approaches (χ², I²). Strength of evidence was assessed using GRADE.

Findings

24 studies fulfilled the criteria to be included in the narrative synthesis and 5 could be included in quantitative analysis. 13 studies evaluated HbA1c POC testing in non-diabetic patients, 9 reported results for diabetic patients and 2 included both groups. The narrative synthesis was constructed around 6 key themes: increased test access, diagnosis of people who would otherwise go undiagnosed, intervention/lifestyle change, POC testing effect on HbA1c and glycaemic control, follow-up time and patient satisfaction.

Interpretation

The available published data supports the proposed use of POC devices in a community setting, with positive effects on diabetic care with limited evidence that patients can achieve better glycaemic control.

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社区环境中已确诊糖尿病患者或有糖尿病风险人群HbA1c水平的护理点测试：一项系统综述和荟萃分析。

背景：使用护理点（POC）检测的糖化血红蛋白（HbA1c）可能具有巨大的实用性，为早期诊断和难以接触的患者群体的定期监测提供了方便的检测。这项系统综述旨在确定成功部署这些设备以改善糖尿病患者预后的证据。方法：2023年2月进行了一项系统综述和荟萃分析，以确定所有相关文章：（CINAHL、Cochrane、PubMed、Scopus和Web of Science）。如果研究报告了糖尿病患者或有糖尿病风险人群的社区POC HbA1c检测结果，则纳入研究。搜索了Prospero数据库和试验登记册。只收录了英文文章。标题、摘要筛选和全文评审由两名评审员（AG/AR）进行。随机研究使用Cochrane偏倚风险工具，观察性队列和横断面研究使用NIH质量评估工具。使用漏斗图和统计评估直观地评估发表偏倚。我们应用固定效应模型对适当的研究进行了荟萃分析。我们使用林地视觉检查和评估方法（χ2，I2）研究了异质性。使用GRADE评估证据强度。结果：24项研究符合纳入叙述综合的标准，5项研究可纳入定量分析。13项研究评估了非糖尿病患者的HbA1c POC检测，9项报告了糖尿病患者的结果，2项包括两组。叙事综合围绕6个关键主题构建：增加检测机会、对未确诊人群的诊断、干预/生活方式的改变、POC检测对HbA1c和血糖控制的影响、随访时间和患者满意度。解释：现有已发表的数据支持在社区环境中使用POC设备的提议，对糖尿病护理有积极影响，但只有有限的证据表明患者可以实现更好的血糖控制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Primary Care Diabetes ENDOCRINOLOGY & METABOLISM-PRIMARY HEALTH CARE

CiteScore

5.00

自引率

3.40%

发文量

134

审稿时长

47 days

期刊介绍： The journal publishes original research articles and high quality reviews in the fields of clinical care, diabetes education, nutrition, health services, psychosocial research and epidemiology and other areas as far as is relevant for diabetology in a primary-care setting. The purpose of the journal is to encourage interdisciplinary research and discussion between all those who are involved in primary diabetes care on an international level. The Journal also publishes news and articles concerning the policies and activities of Primary Care Diabetes Europe and reflects the society''s aim of improving the care for people with diabetes mellitus within the primary-care setting.