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Point-of-care testing of HbA1c and blood glucose in a remote Aboriginal Australian community

David D Martin, Timothy W Jones, Elizabeth A Davis, Mark D S Shephard, Hayley Freeman, Graeme P Maguire and Max K Bulsara
Med J Aust 2005; 182 (10): 524-527.

Summary

Objectives: To assess the accuracy of point-of-care (POC) measurements of capillary blood glucose and glycosylated haemoglobin (HbA1c) levels in a remote Aboriginal community with high diabetes prevalence.

Design: Cross-sectional study comparing POC capillary glucose and HbA1c 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 HbA1c and laboratory glucose and HbA1c measurements.

Main outcome measures: POC fasting capillary levels of glucose (HemoCue Glucose 201 analyser, Medipac Scientific, Sydney) and HbA1c (DCA 2000+ analyser, Bayer Australia, Melbourne); correlation and mean difference between capillary POC and venous blood laboratory measurements of glucose and HbA1c.

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 HbA1c 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 HbA1c. 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 HbA1c (95% CI, − 0.07% to 0.07%; LOA, − 0.66% to 0.66%; P = 0.95), respectively.

Conclusions: POC capillary HbA1c 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.

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  • David D Martin1
  • Timothy W Jones2
  • Elizabeth A Davis3
  • Mark D S Shephard4
  • Hayley Freeman5
  • Graeme P Maguire6
  • Max K Bulsara7

  • 1 Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA.
  • 2 Community Point-of-Care Services, Flinders University Rural Clinical School, Adelaide, SA.
  • 3 Western Australian Country Health Services — Kimberley Region, Broome, WA.
  • 4 School of Population Health and Telethon Institute of Child Health Research, The University of Western Australia, Subiaco, WA.

Correspondence: 

Acknowledgements: 

We thank the members of the community involved in the study, and the Hon Mr Ernie Bridge and his team at the Unity of First Peoples of Australia (UFPA) for their commitment and expertise in the initiation, organisation and coordination of the UFPA diabetes program. We thank Dean Whiting (Manager, Near Patient Testing, Bayer Australia) for the loan of a DCA 2000+ analyser, and for reagents and control specimens, and Michelle Arnebark (Managing Director, Medipac Scientific) for providing HemoCue glucose meters.

David Martin thanks Novo Nordisk for a clinical and research fellowship at Princess Margaret Hospital for Children. We thank Servier Laboratories (Australia) and Bayer Australia for their sponsorship and support of the Community Point-of-Care Services Unit at the Flinders University Rural Clinical School.

Competing interests:

The supporting sources (see Acknowledgements) had no role in study design, data collection, analysis or interpretation, or in writing the article.

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