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There are many fiscal and logistical benefits of using portable A1c devices for both patients and healthcare providers. But what do experts have to say about the efficacy of POC A1c devices? Keep reading this post to find out.
Image Source: Gallup
According to the CDC, 37.3 million Americans—about 1 in 10—have diabetes. About 1 in 5 people with diabetes don't know they have it. But this can be fixed.
Based on these factors, let's visit the benefits and risks of using a POC A1c device.
Increasing the Chance of a Positive Outcome for Diabetes Patients
One of the best features of POC A1c devices is that they can still provide readings the same way an expensive tabletop device or lab equipment would. The only difference is that POC devices are much easier to use in a smaller hospital or FQHC setting.
POC tests can be easily administered in every office where patients visit. They can also be easily used at the patient's home. These tests can catch patients mismanaging their diabetes before they develop irreversible complications that are expensive to treat.
According to the article “Selecting an A1C Point-of-Care Instrument” from the National Institute of Health, “Using a POC device has the potential to improve disease monitoring, therapeutic control, and clinical decision-making during consultations,” and “patients who received immediate A1C feedback via a POC device were found to benefit from it, as evidenced by a 52% greater likelihood of receiving a medical/pharmaceutical intervention and an average A1C reduction of 1.03 ± 0.33 percentage points at 12 months.”
The statistics from this study are incredible proof of the success with which POC A1C devices can provide patients and healthcare providers. If you compare these results to the patients who use commercial laboratory testing, you’ll find that they had an “intervention rate of 27% and an average A1C reduction of 0.33 percentage points,” much lower results than with the POC A1C device.
Thus, the use of a portable A1C device can improve patient care by decreasing the collective A1C levels of patients.
Lower Healthcare Costs
In addition to reducing the severity of chronic disease and improving quality care for all patients, integrating portable A1c devices can help lower healthcare costs.
According to the study from NIH, “the economic impact of tighter glycemic control on overall health care expenditures is evident in the resultant prevention of complications and reduction in the need for specialty care.” As a result, in 3 years, “patients with long-term diabetes complications were found to have paid $33,958 more than patients without complications.”
Ultimately, the more patients are tested for A1c, the quicker they can be treated, and the less money is spent in the long term by the healthcare system to provide care for diabetes complications like eye disease, kidney disease, heart disease, strokes, and more.
Gaps in POC A1C Testing: Experts Debate on Efficacy of POC A1c Devices
After looking at the benefits of POC A1c devices for patients and healthcare providers, let's look at what experts from the ADA have to say about POC A1c devices.
During a Current Issues session sponsored by ADA and the American Association for Clinical Chemistry, experts Jay H. Shubrook, DO, FACOFP, FAAFP, BC-ADM, Professor and Diabetologist, Touro University and David B. Sacks, MB ChB, FACP, FRCPath, Chief, Clinical Chemistry Service, National Institutes of Health debated whether POC A1C devices should be used to diagnose diabetes.
Dr. Shubrook is in support of using POC A1c to diagnose diabetes, though he acknowledges that the sensitivity of current diagnosis methods can vary. Dr. Shubrook used studies to back his knowledge of the strong correlations between POC A1c and clinical laboratory measurements. “I think you should be comfortable that this test can be done and reach comparable accuracy as the laboratory value,” he said.
Dr. Sacks counters with several disadvantages to POC A1c for diagnosing diabetes.
According to Dr. Sacks, “an accurate A1c measurement is required for a diabetes diagnosis, but multiple studies document poor analytic performance of POC A1c devices, with significant differences documented between A1c results obtained by POC devices and lab instruments.”
Assay bias has a significant effect on diagnostic accuracy. Some studies show lab tests with improved accuracy in comparison to POC A1c test results. “If the true (A1c) value is 6.5 and the device has a bias of 0.7, it will tell you that the patient’s A1c is 7.2. Conversely, a negative bias of 0.9 will tell you that a patient, who is at the threshold of diagnosis of diabetes, has an A1c of 5.6, which doesn’t even meet current standards for prediabetes,” Dr. Sacks said.
Considering no proficiency testing is required, lack of training and evaluation of the test performance in clinical settings are other reasons for inaccurate results.
Conclusion
The ultimate goal of POC A1c devices is to aid in quickly and accurately identifying the A1c levels in patients while simultaneously being cost-friendly and easy for healthcare professionals of all ages and skill levels to use.
However, experts are not unanimous in their opinions of POC A1c device use for diabetes diagnosis.
Considering all factors before integrating or using a POC A1c device in your facilities, including the way in which a device measures A1c and how accurate they’re proven to be.
Ask questions: Is the device disposable? Have there been many studies conducted on the device? How does this device compare to others? How does it measure A1c levels? These questions will help you understand the best options available to you or your clinic.
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