2063-P: Implementation of HbA1c Point-of-Care Testing in Primary Care Settings

Abstract

Introduction and Objective: Point-of-care testing (POCT) for hemoglobin A1c (HbA1c) can improve testing frequency and glycemic control. This study evaluated test frequency, change in HbA1c, and diabetes therapy changes among patients with poorly controlled diabetes after introducing HbA1c POCT in primary care settings. Methods: HbA1c POCT was introduced at 6 primary care clinics. Patients with Type 2 diabetes with ≥1 HbA1c test value ≥8.0% within 13 months and no medical conditions affecting red blood cell turnover were eligible for POCT testing during routine clinic visits. The Test Cohort consisted of patients with ≥1 POCT test during the study period. The Control Cohort was selected from sites not participating in the study using propensity score matching to the Test Cohort. Outcomes were compared 13 months pre- and post-implementation of POCT and to the Control Cohort. Logistic regression was used to evaluate the association between test frequency and HbA1c reduction. The time from HbA1c tests to changes in diabetes therapy was calculated. Results: The Test Cohort consisted of N=943 subjects and N=3,003 in the Control Cohort. The number of HbA1c tests per subject in the Test Cohort increased from 2.38 to 2.65 post-implementation of POCT (p=0.002), vs. no change in the Control Cohort (2.11 and 2.16 respectively). There was no significant difference in mean HbA1c reduction between the two Cohorts. In both cohorts, more frequent testing was associated with clinically significant HbA1c reduction (≥0.4%). HbA1c tests >120 days apart were associated with increased HbA1c in both cohorts. In the Test Cohort, 34.8% of intervals between HbA1c tests were >120 days vs. 47.9% in the Control Cohort (p<0.0001). The median time to therapy change was within 1 day of POCT, vs. 7 days for a laboratory HbA1c test. Use of POCT was associated with a higher rate of therapy changes (hazard ratio=1.71, 95% confidence interval=1.53, 1.91). Conclusion: POCT improves HbA1c testing frequency and diabetes therapy changes in primary care settings. More frequent HbA1c testing is associated with lower HbA1c levels. Disclosure R. Khatib: None. J. Brill: None. M. Clendenin: Employee; Current; Abbott. K. Kupfer: Employee; Current; Abbott. Q. Zou: Employee; Current; Abbott Diagnostics. N. Glowacki: None. R. Donovan: None. K. Fortner: Employee; Current; Abbott Diagnostics. N. Ahmed: Employee; Ended; Abbott Diagnostics. Employee; Current; Janssen Research & Development, LLC.