Adapting to telemedicine in the COVID-19 era: Feasibility of dried blood spot testing for hemoglobin A1c

Abstract

Background and aims The COVID-19 pandemic has led to a rapid growth in the use of telemedicine for delivery of ambulatory diabetes care. This study evaluated the feasibility of remote HbA1c monitoring via dried blood spot (DBS) testing to support assessment of glycemic control for telemedicine visits and examined clinical and demographic characteristics associated with patient completion of DBS testing. Methods Providers could place orders for DBS HbA1c 3 weeks prior to telemedicine visits. Feasibility was assessed by examining DBS completion rates, time to completion, and availability of DBS results prior to telemedicine visits. Chi-square tests and Mann Whitney tests were used to assess whether completion rates were associated with participant characteristics. Results Of 303 DBS orders placed for telemedicine visits in June 2020, 162 patients completed the DBS test for a completion rate of (53.4%). Average time from collection at home to result being reported was 6.9 (3.8) days. The DBS result was available in 67.6% of patients who completed successful DBS, before the telemedicine clinic visit. HbA1c was lower in the DBS completion group as compared to the non-completion group (8.2% vs. 8.9%, p = 0.01). No other clinical or demographic characteristics were significantly different between the two groups. Conclusion Remote HbA1c monitoring via DBS is feasible and offers an avenue to support assessment of glycemic control for patients seen via telemedicine. Future work should focus on improving clinic and laboratory processes to support remote DBS collection.

Remote capillary blood collection for HbA1c measurement during the COVID‐19 pandemic: A laboratory and patient perspective

“…Good concordance has been reported in the literature for HbA 1c measured in capillary and venous blood samples using both dried blood spot devices and collection tubes 9,16–19 . Two previous studies reported that 69.2% and 70% of participants, respectively, would use a remote HbA 1c service if available or recommend this service 1,16 .…”

“…Good concordance has been reported in the literature for HbA 1c measured in capillary and venous blood samples using both dried blood spot devices and collection tubes. 9 , 16 , 17 , 18 , 19 Two previous studies reported that 69.2% and 70% of participants, respectively, would use a remote HbA 1c service if available or recommend this service. 1 , 16 Our study gave similar results with over three quarters of respondents (75.4% [43/57]) reporting that they would use the remote HbA 1c service routinely if available.…”

“…An alternative way to increase accessibility to HbA 1c laboratory testing is required in order to support routine HbA 1c testing whilst mitigating the risk of SARS‐CoV‐2 infection and transmission. 1 , 9 The self‐collection of capillary blood samples provides a feasible alternative approach that can support remote provision of care for individuals with diabetes.…”

Newest Diabetes-Related Technologies for Pediatric Type 1 Diabetes and Its Impact on Routine Care: a Narrative Synthesis of the Literature

“…Even during the most restricted lockdown, an Italian group of patients using rt-CGM and followed by telemedicine did not show worsening of their glycemic controls [71]. In another group tested during pandemics, results demonstrated that remote HbA1c monitoring via dried blood spot is feasible and offers an avenue to support assessment of glycemic control for patients seen via telemedicine [72]. Assessments from survey on people with type 1 diabetes during lockdown showed that at least two-thirds underwent changes in the management of their condition [73].…”

A Toolkit for Monitoring Immunoglobulin G Levels from Dried Blood Spots of Patients with Primary Immunodeficiencies

“…To collect a sample the patient performs a finger prick and places one or two drops of capillary blood onto a DBS card, which is then sent to a laboratory for elution and analysis. In the setting of the COVID-19 pandemic, the DBS method has been shown to be a useful remote monitoring tool for the delivery of routine ambulatory care while minimizing hospital visits and the risk of virus exposure [ 7 , 8 ]. A remote monitoring method such as DBS sampling would be beneficial to monitor IgG levels in patients with PID who are at high risk of infections.…”