Pilot study involving the use of point-of-care glycated haemoglobin (HbA1c) testing for screening and monitoring of diabetes mellitus in the public healthcare sector in KwaZulu-Natal

Abstract

Background: The diabetes pandemic continues to cause both patient and economic burden. Globally, strategies to improve glycaemic control in patients with diabetes are highly sought after. One such strategy involves the use of point-of-care glycated haemoglobin (POCT HbA1c) testing, which provides clinicians with rapid information on glycaemic control and also may assist with a diagnosis of diabetes in others. Methods: This pilot study was conducted over three months (December 2019–February 2020) at 21 KwaZulu-Natal (KZN) public healthcare facilities. All patients presenting to the triage units of these facilities had their diabetic history taken and POCT HbA1c, together with their random blood glucose, tested and recorded by nursing staff. These data were forwarded to the Department of Health. Results: A total of 3 541 patients were included in study, 1 306 with diabetes and 2 235 with no prior diabetes history. The median (+IQR) HbA1c% achieved in the diabetes cohort was 6.0 (5.2–8.1) with 32.39% of these patients not achieving target glycaemic control (HbA1c < 7%). This study revealed that a significant proportion of the patients with no history of diabetes mellitus (DM) had evidence of diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%) (45.59% vs. 19.5%, respectively). A total of 361 (16.51%) of these asymptomatic patients with no history of DM had random blood glucose levels of ≥ 11.1 mmol/l. There were significant inter-facility differences noted with regard to the number of patients with diabetes achieving target glycaemic control. Conclusion: This study found that at least one-third of diabetes patients attending these KZN healthcare facilities had sub-optimal control. There was a significant percentage of patients without prior history of DM who had glycaemic levels suggesting dysglycaemia (pre-diabetes and overt diabetes). The Government needs to heed the results of such studies to develop strategies targeting this group of previously undiagnosed diabetes patients. HbA1c point-of-care testing provides one avenue of intervention for both groups of patients.