Rapid Diagnosis and Effective Monitoring of Diabetes Mellitus in Central Vietnam: Point-of-Care Needs, Improved Patient Access, and Spatial Care Paths for Enhanced Public Health

Abstract

Goals Our primary objective was to describe needs for and availability of point-of-care testing for diabetes mellitus diagnosis/monitoring in Central Vietnam. Methods The field survey was designed to determine the status of point-of-care testing at 15 hospitals, comprising 1 provincial hospital (level 2), 7 district hospitals (level 3), and 7 community health centers (level 4) in Hue Province, Central Vietnam. Questions are related to diabetes and prediabetes, acute coronary syndromes, and infectious diseases. Spatial care paths for problem-solving were designed. Acute coronary syndrome results were reported open access elsewhere (see https://journals.lww.com/poctjournal/Pages/articleviewer.aspx?year=2018&issue=09000&article=00001&type=Fulltext). Results Blood glucose testing was limited. Two (28.6%) of 7 community health centers reported having glucose meters available, whereas overall, only 2 (13.3%) of 15 survey sites performed hemoglobin A1c (HbA1c) testing. Diabetes and prediabetes glucose screening cutoffs varied across levels, possibly generating erroneous/missing diagnoses. A diabetes screening program was not reported at the level 2 hospital; availability varied in levels 3 and 4. Glucose meters must be purchased at patients' expense. Microvascular and macrovascular complications, such as kidney failure, retinopathy, and neuropathy, are treated at Hue Central Hospital, the provincial hospital, and some district hospitals. Transfer depends on the extent of patient complications. Ambulance service is extremely limited. Helicopter rescue is not available. Conclusions We conclude the following: (a) diagnostic technologies should be improved; (b) HbA1c and blood glucose instruments must be supplied; (c) public health budgets should fund self-monitoring, glucose meters, and enhanced access; (d) healthcare leaders can create regional spatial care paths to improve outcomes; and (e) diagnostic cutoffs, especially HbA1c, should be harmonized after checking population differences.