Assessing the Clinical Utility of Point of Care HbA1c in the Ophthalmology Outpatient Setting

Abstract

Sunil Mamtora, 1 Panayiotis Maghsoudlou, 1, 2 Hani Hasan, 1 Wenrui Zhang, 3 Mohamed El-Ashry 1 1Department of Ophthalmology, Great Western Hospital, Swindon SN3 6BB, UK; 2Department of Developmental Biology, University College London, London WC1E 6BT, UK; 3Department of Ophthalmology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UKCorrespondence: Panayiotis MaghsoudlouUniversity College London, London, UKTel [phone]Fax [phone]Email [email protected]/Aims: Effective management of diabetic retinopathy requires multidisciplinary input. We aimed to evaluate the impact of point of care (POC) HbA1c testing as a tool to identify patients most in need of specialist diabetologist input and assess the accuracy and determinants of patients’ insight into their glycaemic and blood pressure control.Methods: Forty-nine patients with diabetic retinopathy were recruited from the eye clinic at Great Western Hospital. Patients completed a questionnaire and POC HbA1c and blood pressure values were measured. Statistical analysis was completed with SPSS v23.Results: Mean age was 64.4 years, median interval since the last formal HbA1c reading was 10.2 months and the mean POC HbA1c was 64.1 mmol/mol. HbA1c significantly correlated with the degree of retinopathy. Of the patients, 81.6% had POC readings above the levels recommended by the National Institute for Health and Care Excellence, with only 16.3% having insight into this. Insight to HbA1c levels was predicted by age but not by duration of disease. Fourteen patients (33.3%) identified with high HbA1c readings were referred to secondary diabetic services and 88.8% of patients felt that the test was useful and likely to improve their diabetic control.Conclusion: The majority of patients had poor insight into their diabetes control, with sub-optimal treatment and follow-up. Poor insight is high in younger patients, suggesting that POC HbA1c testing is particularly important in educating younger patients who may be Type 1 diabetics with more severe disease. POC HbA1c represents a cost-effective, reproducible and clinically significant tool for the management of diabetes in an outpatient ophthalmology setting, allowing the rapid recognition of high-risk patients and appropriate referral to secondary diabetic services.Keywords: diabetic retinopathy, glycemic control, point of care testing, HbA1c

Keywords

• diabetic retinopathy
• glycaemic control
• point of care testing
• hba1c.