Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study

Abstract

Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier.Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality.Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device.Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively.Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.

Comparison of diagnostic accuracy for diabetes diagnosis: A systematic review and network meta-analysis

“…Based on our analysis, FPG is more accurate than HbA1c in diabetes diagnosis and, therefore, should be adopted as the diagnostic test of choice for diabetes. Additionally, despite the convenience of HbA1c, this test is unavailable in many low-income settings due to the need for precision and standardization of analytic methods (17)(18)(19), our findings provide critical evidence to support the recommendation of FPG as the preferred diagnostic method for diabetes, especially in limited resources areas. However, more studies on health economic evaluations of these screening tests should be carried out in these settings, to give a comprehensive assessment and make a better decision on resource allocations.…”

Proportion and risk factors of diabetic retinopathy by stage in less-developed rural areas of Hunan province of China: A multi-site cross-sectional study

“…First, the high proportion of DR found in the current study implies that routine DR screening is highly recommended in lessdeveloped rural areas to facilitate early diagnosis and timely intervention. However, rural areas are often confronted with objective challenges such as inconvenient transportation and lack of access to the screening equipment, which may prevent diabetes patients from having DR screening [46]. This indicates that more health resources should be provided to the rural areas such as free diabetes self-management education programs and free DR screening programs.…”

An Assessment of Individual Preference for a Novel Capillary Blood Collection System

“…13–15 In addition, capillary blood collection in ancillary healthcare settings (ie, retail stores) may help improve health care accessibility and reduce the time needed for individual blood collection in rural settings. 16 A recent meta-analysis demonstrated generally positive views from primary care physicians regarding the clinical value of diagnostic assays following capillary blood collection to help increase test coverage and improve turn-around-time for results. 17 …”