Has Glycaemic Control in Diabetes Mellitus Improved Since the Introduction of Point-of-Care Glycated Haemoglobin A1c?

Abstract

Abstract Background: The mortality rate from diabetes-related complications in Sub-Saharan Africa surpassed that of HIV/AIDS, tuberculosis and malaria combined. Point-of-care (POC) glycated haemoglobin (HbA1c) has been in routine use at a tertiary hospital's diabetic clinic in Johannesburg, South Africa. This study set out to determine if having a readily available result on the day of consultation has led to improved glycaemic control. Objective: The aim of this study was to determine if an immediately available POC HbA1c would result in more patients achieving target HbA1c compared to previously used laboratory HbA1c. Methods: A retrospective audit of 195 attendees of the diabetic clinic at a public academic hospital who had been attending before the advent of the POC HbA1c test was recruited. The laboratory HbA1c taken on average 5 years before was compared to the current POC HbA1c to determine if there was any improvement in glycaemic control. Results: The mean HbA1c before the POC test was 8.8% (SD 1.9) and the current POC HbA1c was 8.9% (SD 1.94). There was no statistically significant improvement in glycaemic control. Conclusion: The POC test for HbA1c at a tertiary hospital's diabetic clinic did not result in improved glycaemic control. This study has shown that the introduction of new technology alone may not result in better diabetic care. Comprehensive diabetic care is multifactorial and relies on the intensive efforts of a multidisciplinary team including physician and diabetic nurse educator with active patient participation to ensure optimal glycaemic control.