Point-of-care testing for Hb A<inf>1c</inf> in the management of diabetes: A systematic review and metaanalysis
Al-Ansary L., Farmer A., Hirst J., Roberts N., Glasziou P., Perera R., Price CP.
BACKGROUND: The measurement of hemoglobin A 1c (Hb A 1c ) is employed in monitoring of patients with diabetes. Use of point-of-care testing (POCT) for Hb A1c results at the time of the patient consultation potentially provides an opportunity for greater interaction between patient and caregiver, and more effective care. OBJECTIVE: To perform a systematic review of current trials to determine whether POCT for Hb A 1c , compared with conventional laboratory testing, improves outcomes for patients with diabetes. METHODS: Searches were undertaken on 4 electronic databases and bibliographies from, and hand searches of, relevant journal papers. Only randomized controlled trials were included. The primary outcome measures were change in Hb A 1c and treatment intensification. Metaanalyses were performed on the data obtained. RESULTS: Seven trials were found. There was a nonsignificant reduction of 0.09% (95% CI -0.21 to 0.02) in the Hb A 1c in the POCT compared to the standard group. Although data were collected on the change in proportion of patients reaching a target Hb A 1c of < 7.0%, treatment intensification and heterogeneity in the populations studied and how measures were reported precluded pooling of d ata and metaanalysis. Positive patient satisfaction was also reported in the studies, as well as limited assessments of costs. CONCLUSIONS: There is an absence of evidence in clinical trial data to date for the effectiveness of POCT for Hb A 1c in the management of diabetes. In future studies attention to trial design is needed to ensure appropriate selection and stratification of patients, collection of outcome measures, and action taken upon Hb A 1c results when produced. © 2011 American Association for Clinical Chemistry.