Point-of-care HbA 1c testing in an urban primary care diabetes clinic in South Africa: A mixed methods feasibility study
Hirst JA., Bobrow K., Farmer A., Morgan J., Levitt N.
© 2021 BMJ Publishing Group. All rights reserved. Introduction Monitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA 1c) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa. Subjects 185 adults aged 19-88 years with type 2 diabetes. Materials and methods Participants recruited to this mixed methods cohort study received a point-of-care HbA 1c test. Doctors were asked to use the point-of-care HbA 1c result for clinical decision-making. Qualitative interviews were held with clinical staff. Results Point-of-care HbA 1c test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA 1c, 64 mmol/mol). Medical officers reported using a combination of HbA 1c and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA 1c result to help with decision-making. Discussion Our results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA 1c test result to help them make treatment decisions.