Point-of-care testing for Hb A1c in the management of diabetes: A systematic review and metaanalysis
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BACKGROUND: The measurement of hemoglobin A1c (Hb A1c) 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 A1c, 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 A1c 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 A1c in the POCT compared to the standard group. Although data were collected on the change in proportion of patients reaching a target Hb A1c of
CONCLUSIONS: There is an absence of evidence in clinical trial data to date for the effectiveness of POCT for Hb A1c 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 A1c results when produced.