Point-of-care HbA_1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study.

Abstract

Monitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA_1c) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa. 185 adults aged 19-88 years with type 2 diabetes. Participants recruited to this mixed methods cohort study received a point-of-care HbA_1c test. Doctors were asked to use the point-of-care HbA_1c result for clinical decision-making. Qualitative interviews were held with clinical staff. Point-of-care HbA_1c test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA_1c, 64 mmol/mol). Medical officers reported using a combination of HbA_1c and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA_1c result to help with decision-making. Our results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA_1c test result to help them make treatment decisions.