Alternate Site Testing for Hemoglobin A1C in Children With Diabetes

Abstract

Alternate site testing is appropriate for blood glucose monitoring in euglycemic states, but use of alternate sites for collection of hemoglobin A1C has not been studied. The purpose of this study was to determine whether A1C results obtained from palm or forearm samples are equivalent to A1C results obtained from fingertip samples in a pediatric population. The secondary purposes were to determine whether there were differences in the perceived level of site pain and if there was a site preference. Eighty-four children aged 5 to 20 years with type 1 or type 2 diabetes were randomly assigned to either fingertip and palm (N = 41) or fingertip and forearm (N = 40) groups. A1C samples were obtained in random order with 1 sample immediately following the other. Intraclass correlation coefficients were 0.99 for fingertip and palm, and 0.98 for fingertip and forearm. Paired t tests showed no differences between either set of values. Bland-Altman bias was minimal: -0.01% (95% confidence interval [CI], -0.07% to 0.05%) for the fingertip/palm comparison and 0.0% (95% CI, -0.001 to 0.001) for the fingertip/forearm comparison. The fingertip was preferred by 54.8%, the forearm by 25%, and the palm by 20.2% of the children. Pain ratings were lowest for the forearm followed by the fingertip and palm. Blood samples for measurement of A1C are clinically equivalent from the fingertip and palm or fingertip and forearm. Perceived pain was lowest when samples were obtained from the forearm. Just over half (54.8%) of the children preferred the fingertip.