Experience of point-of-care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study.

To report the observations of point-of-care (POC) glycated hemoglobin (HbA1c) testing in people with non-diabetic hyperglycemia (NDH; HbA1c 42-47 mmol/mol (6.0%-6.4%)), applied in community settings, within the English National Health Service Diabetes Prevention Programme (NHS DPP). A service evaluation assessing prospectively collected national service-level data from the NHS DPP, using data from the first referral received in June 2016-October 2018. Individuals were referred to the NHS DPP with a laboratory-measured HbA1c in the NDH range and had a repeat HbA1c measured at first attendance of the program using one of three POC devices: DCA Vantage, Afinion or A1C Now+. Differences between the referral and POC HbA1c and the SD of the POC HbA1c were calculated. The factors associated with the difference in HbA1c and the association between POC HbA1c result and subsequent attendance of the NHS DPP were also evaluated. Data from 73 703 participants demonstrated a significant mean difference between the referral and POC HbA1c of -2.48 mmol/mol (-0.23%) (t=157, p<0.001) with significant differences in the mean difference between devices (F(2, 73 700)=738, p<0.001). The SD of POC HbA1c was 4.46 mmol/mol (0.41%) with significant differences in SDs between devices (F(2, 73 700)=1542, p<0.001). Participants who were older, from more deprived areas and from Asian, black and mixed ethnic groups were associated with smaller HbA1c differences. Normoglycemic POC HbA1c versus NDH POC HbA1c values were associated with lower subsequent attendance at behavioral interventions (58% vs 67%, p<0.001). POC HbA1c testing in community settings was associated with significantly lower HbA1c values when compared with laboratory-measured referrals. Acknowledging effects of regression to the mean, we found that these differences were also associated with POC method, location, individual patient factors and time between measurements. Compared with POC HbA1c values in the NDH range, normoglycemic POC HbA1c values were associated with lower subsequent intervention attendance.

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Déclaration de conflit d'intérêts

Competing interests: JV is the national clinical director for Diabetes and Obesity at NHS England and is the Clinical Lead for the Healthier You: NHS Diabetes Prevention Programme. EB is the Head of Health Intelligence (diabetes) for Public Health England and leads analysis of the Diabetes Prevention Programme. CB is the primary care advisor to the NHS Diabetes Programme. BY is clinical lead of the National Diabetes Audit for England and Wales and a Trustee of Diabetes UK. KK was chair of the Programme Development Group for the National Institute for Health and Care Excellence (NICE) public health guidance on type 2 diabetes: prevention in people at high risk (NICE PH38). KK is also codirector of the Leicester Diabetes Centre, and one of the programme providers, Ingeus UK Ltd, provide interventions based on the type 2 Diabetes Prevention Programme developed by LDC. NJW was Chair of the Programme Development Group for NICE public health guidance on Type 2 diabetes prevention: population and community-level interventions (NICE PH35). JS represents Public Health England on the NHS England Diabetes Programme Board. SON is the clinical director at Diabetes UK. MS is primary investigator for the NDPS programme. WGJ was chair of the IFCC-WG on Haemoglobin A1c Standardisation and of the IFCC-TF.