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Hrubeniuk TJ, Bouchard DR, Gurd BJ, Sénéchal M. Increasing aerobic exercise intensity fails to consistently improve the glycemic response in people living with prediabetes or type 2 diabetes mellitus: the INTENSITY trial. Appl Physiol Nutr Metab 2024; 49:792-804. [PMID: 38382049 DOI: 10.1139/apnm-2023-0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Some individuals with prediabetes or type 2 diabetes mellitus (T2DM) who engage in exercise will not experience the anticipated improvements in glycemic control, referred to as non-responders. Increasing exercise intensity may improve the proportion of individuals who become responders. The objectives were to (i) identify responders and non-responders based on changes in glycated hemoglobin (HbA1c) in individuals with prediabetes or T2DM following 16 weeks of aerobic exercise; (ii) investigate if increasing exercise intensity enhances the responders' status for individuals not previously responding favourably to the intervention. Participants (n = 40; age = 58.0 years (52.0-66.0); HbA1c = 7.0% (6.0-7.2)) engaged in a two-phase, randomized study design. During phase one, participants performed 16 weeks of treadmill-based, supervised, aerobic exercise at 4.5 metabolic equivalents (METs) for 150 min per week. Thereafter, participants were categorized as responders, non-responders, or unclear based on the 90% confidence interval above, below, or crossing a 0.3% reduction in HbA1c. For phase two, participants were randomized to a maintained intensity (4.5 METs) or increased intensity (6.0 METs) group for 12 weeks. Following phase one, two (4.1%) participants were categorized as responders, four (8.2%) as non-responders, and 43 (87.7%) as unclear. Following phase two, two from the increased intensity group and one from the maintained intensity group experienced an improvement in response categorization. There were no significant between or within group (maintained vs. increased) differences in HbA1c. For most people with prediabetes or T2DM, increasing exercise intensity by 1.5 METs does not improve response categorization.
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Affiliation(s)
- Travis J Hrubeniuk
- Interdisciplinary Studies, University of New Brunswick, Fredericton, NB, Canada
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
| | - Danielle R Bouchard
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
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Glurich I, Berg R, Panny A, Shimpi N, Steinmetz A, Nycz G, Acharya A. Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics. FRONTIERS IN ORAL HEALTH 2021; 2:670355. [PMID: 35048014 PMCID: PMC8757706 DOI: 10.3389/froh.2021.670355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments. Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored. Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures. Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.
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Affiliation(s)
- Ingrid Glurich
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Richard Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Aloksagar Panny
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Neel Shimpi
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Annie Steinmetz
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Greg Nycz
- Family Health Center of Marshfield, Inc., Marshfield Clinic Health System, Marshfield, WI, United States
| | - Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
- Family Health Center of Marshfield, Inc., Marshfield Clinic Health System, Marshfield, WI, United States
- Advocate Aurora Research Institute, LLC, Advocate Aurora Health, Inc., Downers Grove, IL, United States
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Hrubeniuk TJ, Bouchard DR, Gurd BJ, Sénéchal M. Can non-responders be 'rescued' by increasing exercise intensity? A quasi-experimental trial of individual responses among humans living with pre-diabetes or type 2 diabetes mellitus in Canada. BMJ Open 2021; 11:e044478. [PMID: 33820788 PMCID: PMC8030485 DOI: 10.1136/bmjopen-2020-044478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/17/2021] [Accepted: 03/21/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Exercise is recommended to improve glycaemic control. Yet, individual changes in glycaemic control following exercise can vary greatly, meaning while some significantly improve others, coined 'non-responders', do not. Increasing the intensity of exercise may 'rescue' non-responders and help generate a response to training. This trial will identify non-responders to changes in glycated haemoglobin (HbA1c) across inactive individuals living with pre-diabetes or type 2 diabetes mellitus following an aerobic exercise programme and evaluate if increasing training intensity will elicit beneficial changes to 'rescue' previously categorised non-responders. METHODS AND ANALYSIS This study will recruit 60 participants for a two-phase aerobic exercise training programme. Participants will be allocated to a control group or assigned to an intervention group. Control participants will maintain their current lifestyle habits. During phase 1, intervention participants will complete 16 weeks of aerobic exercise at an intensity of 4.5 metabolic equivalents (METs) for 150 min per week. Participants will then be categorised as responders or non-responders based on the change in HbA1c. For phase 2, participants will be blocked based on responder status and randomly allocated to a maintained intensity, or increased intensity group for 12 weeks. The maintained group will continue to train at 4.5 METs, while the increased intensity group will train at 6.0 METs for 150 min per week. ETHICS AND DISSEMINATION Results will be presented at scientific meetings and submitted to peer-reviewed journals. Publications and presentations related to the study will be authorised and reviewed by all investigators. Findings from this study will be used to provide support for future randomised control trials. All experimental procedures have been approved by the Research Ethics Board at the University of New Brunswick (REB: 2018-168). TRIAL REGISTRATION NUMBER NCT03787836.
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Affiliation(s)
- Travis J Hrubeniuk
- Interdisciplinary Studies, University of New Brunswick, Fredericton, New Brunswick, Canada
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Danielle R Bouchard
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, New Brunswick, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, New Brunswick, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
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van Raalten F, Hiemstra YL, Keulen N, van Duivenvoorde Y, Stoecklein K, Verhagen EA, Boer C. Level of agreement of point-of-care and laboratory HbA1c measurements in the preoperative outpatient clinic in non-diabetic patients who are overweight or obese. J Clin Monit Comput 2019; 33:1139-1144. [PMID: 30659411 PMCID: PMC6823319 DOI: 10.1007/s10877-019-00255-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022]
Abstract
Implementation of point-of-care HbA1c devices in the preoperative outpatient clinic might facilitate the early diagnosis of glycemic disturbances in overweight or obese patients undergoing surgery, but validation studies in this setting do not exist. We determined the level of agreement between a point-of-care and laboratory HbA1c test in non-diabetic patients visiting the outpatient clinic for preoperative risk profiling. Point-of-care HbA1c levels were measured in whole blood obtained by a finger prick (Siemens DCA Vantage HbA1c analyzer) and in hemolysed EDTA blood in the central laboratory (LAB). Bland Altman and Clarke's error grid analysis were used to analyze the agreement between the point-of-care and laboratory measurements. Patients (n = 49) were 55 ± 11 years old, 47% were male with a body mass index (BMI) of 30.6 ± 3.4 kg/m2. The mean HbA1c was 38.1 ± 3.7 mmol/mol or 5.6 ± 0.3%. One patient was diagnosed with a HbA1c indicative for diabetes mellitus (6.7%). Bland Altman analysis revealed a bias of - 0.53 ± 1.81 mmol/mol with limits of agreement of - 4.09 to 3.03 mmol/mol and a bias of - 0.05 ± 0.17% with limits of agreement - 0.39 to 0.28%. The percentage error was 9.2% and 5.9% for HbA1c expressed in mmol/mol and %, respectively. Clarke's error grid analysis showed that 48 out of 49 measurements were located in area A (98%). Point-of-care HbA1c measurements showed a high level of agreement with the laboratory test in the outpatient setting, and may be used for preoperative risk profiling in patients prone to cardiometabolic complications.Trial registration: Netherlands Trial Register NTR3057.
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Affiliation(s)
- Floris van Raalten
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Yasmine L Hiemstra
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Noor Keulen
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Yoni van Duivenvoorde
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Katrin Stoecklein
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Evert A Verhagen
- Department of Public & Occupational Health, Amsterdam UMC, VU University, Amsterdam Public Health, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Christa Boer
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands.
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Dubach IL, Christ ER, Diem P. HbA 1c-testing: Evaluation of two point-of-care analysers. Prim Care Diabetes 2019; 13:583-587. [PMID: 31175054 DOI: 10.1016/j.pcd.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND HbA1c is a critical parameter for the medical management of patients with diabetes mellitus. Interventions that reduce HbA1c levels lead to a diminution of microvascular complications. For two decades, point of care testing (POCT) methods have been regularly used to measure HbA1c. The results significantly impact on the management of patients with diabetes mellitus and the accuracy of the results is critical. It is important to know the performance of common methods of HbA1c measurements in daily life. We, therefore, aimed at evaluating the accuracy of two different analysers especially developed for POCT and compared them to a reference method. METHODS We prospectively tested two widely used POCT methods to measure HbA1c, namely Afinion™ AS100 Analyzer (Axis-Shield, Oslo Norway) and DCA Vantage™ Analyzer (Siemens Healthcare Diagnostics, Tarrytown NY, US) in venous samples of 100 patients. As a reference method, we used the high-performance liquid chromatography method G8 HPLC used in the Biochemistry Laboratory of the Inselspital Bern. The National Glycohaemoglobin Standardization Program (NGSP) has certificated all methods used in this study. The comparability and degree of agreement was assessed using Bland-Altman plot. RESULTS The HbA1c levels ranged from 33 to 116 mmol/mol (5.2-12.8%), 31-122 mmol/mol (5.0-13.3%) and 30-119 mmol/mol (4.9-13%) for Afinion™, DCA Vantage™ and G8 HPLC Analyzer, respectively. The 95% limits of agreement were between -0.84 and +0.30 for the Afinion™ and -0.71 and +0.29 for DCA Vantage™. The results of both POCT were significantly lower with a bias of -0.27% and -0.21% (p < 0.0001) for Afinion™ and DCA Vantage™ Analyzer, respectively. CONCLUSIONS The POCT methods tested in this study showed a good correlation with the laboratory reference method, however, with an overall negative bias.
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Affiliation(s)
- Irina L Dubach
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland; Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Emanuel R Christ
- Division of Endocrinology, Diabetes and Metabolism, University of Basel, Basel, Switzerland
| | - Peter Diem
- Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
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Lenters-Westra E, English E. Analysis: Investigating the quality of POCT devices for HbA1c, what are our next steps? J Diabetes Sci Technol 2019; 13:1154-1157. [PMID: 31113240 PMCID: PMC6835179 DOI: 10.1177/1932296819850838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There are a growing number of publications evaluating the performance of HbA1c point-of-care testing (POCT) devices when compared to routine laboratory instruments, but is this what we need from future studies? Here we describe the current understanding of the performance of POCT for HbA1c, which areas need further studies, and the key requirements for future publications based on performance evaluations of these devices. These include studies in clinical settings, performance measured against internationally standardized reference methods, and the need to evaluate new to the market devices that do not currently have a detailed performance history. In addition we highlight the need for external quality assessment schemes that are designed to support POCT in a wide range of clinical settings.
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Affiliation(s)
- Erna Lenters-Westra
- Department of Clinical Chemistry, Isala, Zwolle, The Netherlands
- European Reference Laboratory for Glycohemoglobin, location Isala, Zwolle, The Netherlands
- Erna Lenters-Westra, PhD, Isala, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Emma English
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
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Are point-of-care measurements of glycated haemoglobin accurate in the critically ill? Aust Crit Care 2018; 32:465-470. [PMID: 30591312 DOI: 10.1016/j.aucc.2018.11.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Critically ill patients with type 2 diabetes mellitus (T2DM) and chronic hyperglycaemia may benefit from a more liberal approach to glucose control than patients with previously normal glucose tolerance. It may therefore be useful to rapidly determine HbA1c concentrations. Point-of-care (POC) analysers offer rapid results but may be less accurate than laboratory analysis. AIM(S) The aim of this study was to determine agreement between POC and laboratory HbA1c testing in critically ill patients with T2DM. METHODS Critically ill patients with T2DM had concurrent laboratory, capillary-, and arterial-POC HbA1c measurements performed. Data are presented as mean (standard deviation) or median [interquartile range]. Measurement agreement was assessed by Lin's concordance correlation coefficient, Bland-Altman 95% limits of agreement, and classification by Cohen's kappa statistic. RESULTS HbA1c analysis was performed for 26 patients. The time to obtain a result from POC analysis took a median of 9 [7, 10] minutes. Laboratory analysis took a median of 328 [257, 522] minutes from the time of test request to the time of report. Lin's correlation coefficient showed almost perfect agreement (0.99%) for arterial- vs capillary-POC and both POC methods vs arterial laboratory analysis. Bland-Altman plots showed a mean difference of 2.0 (3.7) with 95% limits of agreement of -5.4 to 9.3 for capillary vs laboratory, 1.6 (3.4) and -5.1 to 8.4 for arterial vs laboratory, and -0.137 (2.6) and -5.2 to 4.9 for capillary vs arterial. Patient classification as having inadequately controlled diabetes (>53 mmol/mol) showed 100% agreement across all tests. CONCLUSIONS HbA1c values can be accurately and rapidly obtained using POC testing in the critically ill.
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Saxton AT, Miranda JJ, Ortiz EJ, Pan W. Assessment of Two Diabetes Point-of-care Analyzers Measuring Hemoglobin A1c in the Peruvian Amazon. Ann Glob Health 2018. [PMID: 30779508 PMCID: PMC6748252 DOI: 10.29024/aogh.2368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: With an estimated 174 million undiagnosed cases of diabetes mellitus worldwide and 80% of them occurring in low- and middle-income countries an effective point-of-care diagnostic tool is key to fighting this global epidemic. Glycated hemoglobin has become a reliable biomarker for the diagnosis and prognosis of diabetes. Objective: We assessed two point-of-care (POC) analyzers in multi-ethnic communities of the Amazon Rainforest in Peru where laboratory-based glycated hemoglobin (HbA1c) testing is not available. Methods: 203 venous blood samples were tested for HbA1c by Afinion and DCA Vantage analyzers as well as a Premier Hb9210 high-performance liquid chromatography (HPLC) method as the reference standard. The coefficient of variation (CV) of each device was calculated to assess assay imprecision. Bland-Altman plots were used to assess bias. Ambient temperature, humidity, and barometric pressure were also evaluated for their effect on HbA1c results using multivariate regression. Findings: There was a wide range of HbA1c for participants based on the HPLC test: 4.4–9.0% (25–75 mmol/mol). The CV for the Afinion was 1.75%, and 4.01% for Vantage. The Afinion generated higher HbA1c results than the HPLC (mean difference = +0.56% [+6 mmol/mol]; p < 0.001), as did the DCA Vantage (mean difference = +0.32% [4 mmol/mol] p < 0.001). Temperature and humidity were not related to HbA1c; however, barometric pressure was associated with HPLC HbA1c results for the Afinion. Conclusions: Imprecision and bias were not low enough to recommend either POC analyzer for HbA1c determinations in this setting.
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Affiliation(s)
- Anthony T Saxton
- Duke Global Health Institute, Duke University.,Miller School of Medicine, Miami University, US
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia.,School of Medicine, Universidad Peruana Cayetano Heredia, PE
| | | | - William Pan
- Duke Global Health Institute, Duke University.,Nicholas School of the Environment, Duke University, US
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Saxton AT, Miranda JJ, Ortiz EJ, Pan W. Assessment of Two Diabetes Point-of-care Analyzers Measuring Hemoglobin A1c in the Peruvian Amazon. Ann Glob Health 2018; 84:618-624. [PMID: 30779508 PMCID: PMC6748252 DOI: 10.9204/aogh.2368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With an estimated 174 million undiagnosed cases of diabetes mellitus worldwide and 80% of them occurring in low- and middle-income countries an effective point-of-care diagnostic tool is key to fighting this global epidemic. Glycated hemoglobin has become a reliable biomarker for the diagnosis and prognosis of diabetes. OBJECTIVE We assessed two point-of-care (POC) analyzers in multi-ethnic communities of the Amazon Rainforest in Peru where laboratory-based glycated hemoglobin (HbA1c) testing is not available. METHODS 203 venous blood samples were tested for HbA1c by Afinion and DCA Vantage analyzers as well as a Premier Hb9210 high-performance liquid chromatography (HPLC) method as the reference standard. The coefficient of variation (CV) of each device was calculated to assess assay imprecision. Bland-Altman plots were used to assess bias. Ambient temperature, humidity, and barometric pressure were also evaluated for their effect on HbA1c results using multivariate regression. FINDINGS There was a wide range of HbA1c for participants based on the HPLC test: 4.4-9.0% (25-75 mmol/mol). The CV for the Afinion was 1.75%, and 4.01% for Vantage. The Afinion generated higher HbA1c results than the HPLC (mean difference = +0.56% [+6 mmol/mol]; p < 0.001), as did the DCA Vantage (mean difference = +0.32% [4 mmol/mol] p < 0.001). Temperature and humidity were not related to HbA1c; however, barometric pressure was associated with HPLC HbA1c results for the Afinion. CONCLUSIONS Imprecision and bias were not low enough to recommend either POC analyzer for HbA1c determinations in this setting.
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Affiliation(s)
- Anthony T. Saxton
- Duke Global Health Institute, Duke University, Durham, NC, US
- Miller School of Medicine, Miami University, Miami, FL, US
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, PE
| | | | - William Pan
- Duke Global Health Institute, Duke University, Durham, NC, US
- Nicholas School of the Environment, Duke University, Durham, NC, US
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Kaur J, Jiang C, Liu G. Different strategies for detection of HbA1c emphasizing on biosensors and point-of-care analyzers. Biosens Bioelectron 2018; 123:85-100. [PMID: 29903690 DOI: 10.1016/j.bios.2018.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/23/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022]
Abstract
Measurement of glycosylated hemoglobin (HbA1c) is a gold standard procedure for assessing long term glycemic control in individuals with diabetes mellitus as it gives the stable and reliable value of blood glucose levels for a period of 90-120 days. HbA1c is formed by the non-enzymatic glycation of terminal valine of hemoglobin. The analysis of HbA1c tends to be complicated because there are more than 300 different assay methods for measuring HbA1c which leads to variations in reported values from same samples. Therefore, standardization of detection methods is recommended. The review outlines the current research activities on developing assays including biosensors for the detection of HbA1c. The pros and cons of different techniques for measuring HbA1c are outlined. The performance of current point-of-care HbA1c analyzers available on the market are also compared and discussed. The future perspectives for HbA1c detection and diabetes management are proposed.
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Affiliation(s)
- Jagjit Kaur
- Graduate School of Biomedical Engineering, ARC Centre of Excellence in Nanoscale Biophotonics (CNBP), Faculty of Engineering, The University of New South Wales, Sydney 2052, Australia; Australian Centre for NanoMedicine, The University of New South Wales, Sydney 2052, Australia
| | - Cheng Jiang
- Nuffield Department of Clinical Neurosciences, Department of Chemistry, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Guozhen Liu
- Graduate School of Biomedical Engineering, ARC Centre of Excellence in Nanoscale Biophotonics (CNBP), Faculty of Engineering, The University of New South Wales, Sydney 2052, Australia; Australian Centre for NanoMedicine, The University of New South Wales, Sydney 2052, Australia; International Joint Research Center for Intelligent Biosensor Technology and Health, Central China Normal University, Wuhan 430079, PR China.
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Unwin N, Howitt C, Rose AMC, Samuels TA, Hennis AJM, Hambleton IR. Prevalence and phenotype of diabetes and prediabetes using fasting glucose vs HbA1c in a Caribbean population. J Glob Health 2017; 7:020407. [PMID: 28959440 PMCID: PMC5604098 DOI: 10.7189/jogh.07.020407] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Both fasting plasma glucose (FPG) and HbA1c are recommended for the diagnosis of diabetes and prediabetes by the American Diabetes Association (ADA), and for diabetes by the World Health Organization. The ADA guidance is influential on clinical practice in many developing countries, including in the Caribbean and Latin America. We aimed to compare the prevalence and characteristics of individuals identified as having diabetes and prediabetes by FPG and HbA1c in a predominantly African ancestry Caribbean population. METHODS A representative population-based sample of 1234 adults (≥25 years of age) resident in Barbados was recruited. Standard methods with appropriate quality control were used to collect data on height, weight, blood pressure, fasting lipids and history of diagnosed diabetes, and to measure fasting glucose and HbA1c. Those with previously diagnosed diabetes (n = 192) were excluded from the analyses. Diabetes was defined as: FPG ≥7.0 mmol/L or HbA1c ≥6.5%; prediabetes as: FPG ≥5.6 to <7mmol/L or HbA1c ≥5.7 to <6.5%. RESULTS Complete data were available on 939 participants without previously diagnosed diabetes. The prevalence of undiagnosed diabetes was higher, but not significantly so, by HbA1c (4.9%, 95% CI 3.5, 6.8) vs FPG (3.5%, 2.4, 5.1). Overall 79 individuals had diabetes by either measure, but only 21 on both. The prevalence of prediabetes was higher by HbA1c compared to FPG: 41.7% (37.9, 45.6) vs 15.0% (12.8, 17.5). Overall 558 individuals had prediabetes by either measure, but only 107 on both. HbA1c, but not FPG, was significantly higher in women than men; and FPG, but not HbA1c, was significantly associated with raised triglycerides and low HDL cholesterol. CONCLUSION The agreement between FPG and HbA1c defined hyperglycaemia is poor. In addition, there are some differences in the phenotype of those identified, and HbA1c gives a much higher prevalence of prediabetes. The routine use of HbA1c for screening and diagnosis in this population would have major implications for clinical and public health policies and resources. Given the lack of robust evidence, particularly for prediabetes, on whether intervention in the individuals identified would improve outcomes, this approach to screening and diagnosis cannot be currently recommended for this population.
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Affiliation(s)
- Nigel Unwin
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Christina Howitt
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Angela MC Rose
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - T Alafia Samuels
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Anselm JM Hennis
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Ian R Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
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Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL. Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemp Clin Trials 2017; 54:8-17. [PMID: 28064028 DOI: 10.1016/j.cct.2016.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 12/07/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023]
Abstract
OVERVIEW This paper describes the study protocol used to evaluate the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) intervention and reports on baseline characteristics of recruited participants. REAL Diabetes is an activity-based intervention designed to address the needs of young adults diagnosed with type 1 (T1D) or type 2 diabetes (T2D) from low socioeconomic status or racial/ethnic minority backgrounds. The REAL intervention incorporates tailored delivery of seven content modules addressing various dimensions of health and well-being as they relate to diabetes, delivered by a licensed occupational therapist. METHODS In this pilot randomized controlled trial, participants are assigned to the REAL Diabetes intervention or an attention control condition. The study's primary recruitment strategies included in-person recruitment at diabetes clinics, mass mailings to clinic patients, and social media advertising. Data collection includes baseline and 6-month assessments of primary outcomes, secondary outcomes, and hypothesized mediators of intervention effects, as well as ongoing process evaluation assessment to ensure study protocol adherence and intervention fidelity. RESULTS At baseline, participants (n=81) were 51% female, 78% Latino, and on average 22.6years old with an average HbA1c of 10.8%. A majority of participants (61.7%) demonstrated clinically significant diabetes distress and 27.2% reported symptoms consistent with major depressive disorder. Compared to participants with T1D, participants with T2D had lower diabetes-related self-efficacy and problem-solving skills. Compared to participants recruited at clinics, participants recruited through other strategies had greater diabetes knowledge but weaker medication adherence. DISCUSSION Participants in the REAL study demonstrate clinically significant medical and psychosocial needs.
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Affiliation(s)
- Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA.
| | - Kristine Carandang
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA
| | - Cheryl Vigen
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA
| | - Jeanine Blanchard
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, 2020 Zonal Ave, Rm. 115, Los Angeles, CA 90033, USA
| | - Jamie R Wood
- Department of Pediatrics, University of Southern California, 2020 Zonal Ave, Rm. 115, Los Angeles, CA 90033, USA; Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS # 61, Los Angeles, CA 90027, USA
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, MC 9239, Los Angeles, CA 90089, USA
| | - Robin Whittemore
- Yale School of Nursing, 100 Church Street South, P.O. Box 9740, New Haven, CT 06536-0740, USA
| | - Anne L Peters
- Division of Endocrinology, University of Southern California, 9033 Wilshire Blvd. Suite 406, Beverly Hills, CA 90211, USA
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Yu HJ, Lim S, Kwon MJ, Woo HY, Park H. Evaluation of Cobas b 101 HbA1c Analyzer Performance for Point-of-Care Testing. ACTA ACUST UNITED AC 2017. [DOI: 10.3343/lmo.2017.7.4.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Hui-Jin Yu
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangeun Lim
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Yeon Woo
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyosoon Park
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Paknikar S, Sarmah R, Sivaganeshan L, Welke A, Rizzo A, Larson K, Rendell M. Long-Term Performance of Point-of-Care Hemoglobin A1c Assays. J Diabetes Sci Technol 2016; 10:1308-1315. [PMID: 27113451 PMCID: PMC5094320 DOI: 10.1177/1932296816645362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Point-of-care (POC) testing of HbA1c is used as a time-efficient tool to improve treatment and management planning for diabetes in the clinic setting. HbA1c values are the basis for monitoring ongoing response to treatment and to make adjustments to diabetes therapy. Yet, there is ongoing controversy as to the accuracy of POC assays. Diabetes is a lifelong disease, so comparability of results over a long period of time is needed to follow the response to treatment. METHODS We compared the Afinion™ automated boronate affinity assay and the DCA Vantage immunoassay-based POC techniques to the Tosoh G8 and Bio-Rad Variant II ion-exchange high-performance liquid chromatography (HPLC) central laboratory methods in a study lasting 3 years. College of American Pathology Survey results and American Proficiency testing were utilized to assess the external validity of the POC techniques. RESULTS Despite high correlations among the 4 techniques, there were significant and variable differences obtained over time. The Biorad values varied from 0.1 to 0.4% higher than the Afinion values. The DCA results were usually higher than the Afinion values, but fell below the Afinion results in the last 6 months of our study. Both POC techniques gave systematically lower values than the Tosoh measurements, and both the POC and the central laboratory measurements showed variable differences from the National Glycohemoglobin Standardization Program values over the duration of this study. CONCLUSIONS All who rely on POC methods as well as on central laboratory measurement of HbA1c must understand the potential limitations of these assays. The assessment of diabetes blood sugar control should proceed from the evaluation of HbA1c combined with review of plasma glucose and of self-monitored blood glucose values.
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Affiliation(s)
| | | | | | - Adam Welke
- Creighton Diabetes Center, Omaha, NE, USA
| | - Al Rizzo
- Creighton Diabetes Center, Omaha, NE, USA
| | | | - Marc Rendell
- Creighton Diabetes Center, Omaha, NE, USA
- Rose Salter Medical Research Foundation, Omaha, NE, USA
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Herpol M, Lanckmans K, Van Neyghem S, Clement P, Crevits S, De Crem K, Gorus FK, Weets I. Evaluation of the Sebia Capillarys 3 Tera and the Bio-Rad D-100 Systems for the Measurement of Hemoglobin A1c. Am J Clin Pathol 2016; 146:67-77. [PMID: 27357293 DOI: 10.1093/ajcp/aqw081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We evaluated the Bio-Rad (Irvine, CA) D-100 and the Sebia (Lisses, France) Capillarys 3 Tera for the measurement of hemoglobin A1c (HbA1c) in venous blood samples. METHODS Whole-blood samples and control material were analyzed with the D-100 and Capillarys 3 Tera and compared with our routine method, HLC-723G7 (Tosoh, Tokyo, Japan). An evaluation protocol to test precision, trueness, linearity, carryover, and selectivity was set up according to Clinical and Laboratory Standards Institute guidelines. The results were presented in National Glycohemoglobin Standardization Program and International Federation of Clinical Chemistry (IFCC) units. RESULTS Both systems showed excellent precision (total coefficients of variation <2%, IFCC) and bias (<0.3% or 3 mmol/mol). Linearity was demonstrated for HbA1c values from 3.8% (18 mmol/mol) to 18.5% (179 mmol/mol). Results were correlated with the routine method using Bland-Altman analysis, showing a mean difference of 0.33% or 3.6 mmol/mol for the D-100 and of 0.25% or 2.6 mmol/mol for the Capillarys 3 Tera vs HLC-723G7. None of the automated instruments were prone to interferences by labile HbA1c (≤10 g/L glucose), carbamylated hemoglobin (≤0.5 mmol/L potassium cyanate), hemoglobin variants, bilirubin (≤15 mg/dL), and triglycerides (≤3,360 mg/dL). CONCLUSIONS The Bio-Rad D-100 and the Sebia Capillarys 3 Tera instruments performed well for the determination of HbA1c in terms of quality criteria as well as for sample throughput.
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Affiliation(s)
- Margaux Herpol
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Katrien Lanckmans
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stefaan Van Neyghem
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pascale Clement
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stefanie Crevits
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kim De Crem
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Frans K Gorus
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ilse Weets
- From the Department of Clinical Chemistry and Radio-Immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
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16
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Rausch S, Hennenlotter J, Wiesenreiter J, Hohneder A, Heinkele J, Schwentner C, Stenzl A, Todenhöfer T. Assessment of a new point-of-care system for detection of prostate specific antigen. BMC Urol 2016; 16:4. [PMID: 26785797 PMCID: PMC4719541 DOI: 10.1186/s12894-016-0119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Measurement of the prostate specific antigen (PSA) remains an important tool in prostate cancer (PC) diagnosis. Due to limited availability of laboratory devices in an outpatient setting, compact and easy-to-handle point-of-care (POC) systems are desirable. Recently, a chip for PSA measurement on the concile® Ω100 POC reader platform was introduced. To investigate the clinical applicability, we evaluated the system in a consecutive cohort of patients undergoing PSA measurement in our outpatient clinic. Methods Between 07/2014 and 01/2015, PSA was analyzed in a total of 198 patients by the POC reader system and in parallel by an Immulite 2000® and Centaur® standard laboratory system, respectively. By standard (Immulite®) measurement, 67 (34,2 %) had PSA > 4 ng/ml and 131 (65,8 %) had PSA ≤ 4 ng/ml. Results were correlated by linear regression analyses for all patients and within PSA subgroups. For patients with available prostate histology after PSA measurement (n = 68), receiver-operating characteristic curves were created and area under the curve (AUC), sensitivity and specificity for the prediction of PC at best cut-off value were calculated. Results The coefficients of determination (r2) for the POC device compared to laboratory testing were 0.72 (Immulite®) and 0.63 (Centaur®), respectively (both p < 0.0001). In the PSA range of ≤4 ng/ml, the observed correlations were 0.75 and 0.70, respectively. For the POC test system, AUC for detection of PC was calculated with 0.745 while the standard laboratory tests showed 0.778 (Immulite®) and 0.771 (Centaur®). At best cut-off of 3.64 ng/ml, PSA analysis by the POC system showed a sensitivity of 85.7 % and a specificity of 66.7 %. Conclusions The POC system obtained good concordance to elaborate laboratory measurement. In a screening scenario, the system provides quick and reliable PSA measurement, especially in the PSA range up to 4 ng/ml.
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Affiliation(s)
- Steffen Rausch
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Joerg Hennenlotter
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Josef Wiesenreiter
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Andrea Hohneder
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Julian Heinkele
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Christian Schwentner
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Tilman Todenhöfer
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, V6H 3Z6, Canada.
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Torregrosa ME, Molina J, Argente CR, Ena J. Evaluación de tres sistemas de determinación rápida de hemoglobina A1c para monitorización del control glucémico en pacientes con diabetes mellitus. ACTA ACUST UNITED AC 2015; 62:478-84. [DOI: 10.1016/j.endonu.2015.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/29/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
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18
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Torregrosa ME, Molina J, Argente CR, Ena J. Accuracy of three hemoglobin A1c point-of-care systems for glucose monitoring in patients with diabetes mellitus. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.endoen.2015.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Optimizing Point-of-Care Testing for Diabetes Management in a Rural Australian General Practice. POINT OF CARE 2015. [DOI: 10.1097/poc.0000000000000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ang SH, Thevarajah M, Alias Y, Khor SM. Current aspects in hemoglobin A1c detection: A review. Clin Chim Acta 2015; 439:202-11. [DOI: 10.1016/j.cca.2014.10.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 11/29/2022]
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Villar-del-Campo MC, Rodríguez-Caravaca G, Gil-Yonte P, Cidoncha-Calderón E, García-Cruces Méndez J, Donnay-Pérez S. [Diagnostic agreement between two glycosylated a1b hemoglobin methods in Primary Care]. Semergen 2014; 40:431-5. [PMID: 24708908 DOI: 10.1016/j.semerg.2014.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Several methods are available for measuring glycosylated A1c hemoglobin (HbA1c), all rapid methods for point of care use in a clinical or laboratory setting. This study attempts to compare the diagnostic agreement between two methods for detection of HbA1c. MATERIAL AND METHODS A descriptive cross-sectional study of diagnostic agreement was carried out in the Los Carmenes Health Centre. Two groups of patients -with and without type 2 diabetes- were consecutively included. A method for point-of-care use in a Primary Care Clinic setting (DCA(TM) Systems Siemens(®)) was compared with a laboratory test (chromatographic analysis). An analysis was made of the mean concentration of HbA1c, the agreement between methods, using the intra-class correlation coefficient (CCLA1) and the Bland-Altman method. RESULTS A total of 102 patients were included, 62 diabetic (60.8%) and 40 non-diabetic (39.2%). The overall mean HbA1c was 6.46% (SD=0.88) in the analysis using capillary blood in the clinic with the DCA™ system, and 6.44% (SD=0.86) using the laboratory test (P>.05). The degree of agreement between the two tests was 0.975 (95% CI: 0.963-0.983). The mean of the differences between the results of the two assessed tests was 0.024 (SD=0.27). The percentage of points outside the limits of optimal agreement, as defined in the Bland-Altman graph, was 2.5%. CONCLUSIONS Diagnostic agreement between a method for point-of-care use in a Primary Health Care Clinic and a laboratory test was very high. Detection at the point-of-care allows a quick and simple assessment of HbA1c.
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Affiliation(s)
| | - G Rodríguez-Caravaca
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Fundación Alcorcón, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España.
| | - P Gil-Yonte
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - E Cidoncha-Calderón
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - J García-Cruces Méndez
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - S Donnay-Pérez
- Unidad de Endocrinología y Nutrición, Hospital Universitario Fundación Alcorcón, Madrid, España
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Wan Mohd Zin RM, Ahmad Kamil ZI, Tuan Soh TR, Embong M, Wan Mohamud WN. Haemoglobin A1c: comparing performance of two point of care devices with laboratory analyser. BMC Res Notes 2013; 6:540. [PMID: 24344903 PMCID: PMC3878320 DOI: 10.1186/1756-0500-6-540] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/15/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Measurement of HbA1c has been widely used for long-term monitoring and management of diabetes control. There is increasing use of point-of-care (POC) devices for measuring HbA1c where quicker results would allow immediate clinical management decisions to be made. Therefore, it is important to evaluate and compare the performance of such devices to the reference laboratory method. FINDINGS A total of 274 venous blood was collected from normal healthy adults during the community screening programmes. The performance of POC devices, Afinion and Quo-test were compared to central laboratory HPLC method; Adams A1c HA 8160. Both POC devices showed good correlation to HA 8160 with r = 0.94 (p < 0.001) and r = 0.95 (p < 0.001) for Afinion and Quo-test respectively. The means difference were statistically higher between POC and HA 8160 with 0.23% (95% CI 0.19-0.26, p < 0.001) and 0.29% (95% CI 0.24-0.34, p < 0.001) for Afinion and Quo-test respectively. CONCLUSIONS Both POC devices could be considered in health clinics for diabetes management but not to be used for the diagnostic purposes.
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Affiliation(s)
- Ruziana Mona Wan Mohd Zin
- Department of Diabetes & Endocrine, Cardiovascular Diabetes and Nutrition Research Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, 50588, Malaysia
| | - Zati Iwani Ahmad Kamil
- Department of Diabetes & Endocrine, Cardiovascular Diabetes and Nutrition Research Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, 50588, Malaysia
| | - Tuan Rosidah Tuan Soh
- Department of Diabetes & Endocrine, Cardiovascular Diabetes and Nutrition Research Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, 50588, Malaysia
| | - Mustaffa Embong
- Department of Medical, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
- National Diabetes Institute, Jalan SS 3/50, Petaling Jaya, Selangor, 47300, Malaysia
| | - Wan Nazaimoon Wan Mohamud
- Department of Diabetes & Endocrine, Cardiovascular Diabetes and Nutrition Research Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, 50588, Malaysia
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Malkani S, Korpi-Steiner N, Rao LV. Reducing analytical variation between point-of-care and laboratory HbA1c testing. J Diabetes 2013; 5:192-6. [PMID: 23035661 DOI: 10.1111/1753-0407.12009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 08/24/2012] [Accepted: 09/23/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Point-of-care (POC) HbA1c testing allows for timely treatment changes, improved glycemic control, and patient and provider satisfaction. Substantial variation between POC and laboratory HbA1c results has been reported. At our university hospital diabetes clinic, we observed significant negative bias in HbA1c with the DCA Vantage (Siemens Healthcare Diagnostics, Tarrytown, NY, USA) compared with the Tosoh G8 HPLC laboratory analyzer (Tosoh Bioscience, San Francisco, CA, USA). This led us to systematically analyze the bias with the goal of recalibrating the DCA to minimize bias. METHODS We analyzed 45 patient samples, with HbA1c ranging between 5% and 10.8%, concurrently on two DCA analyzers and on the Tosoh G8 machine. The bias for each sample was the difference between the value on the DCA and the Tosoh G8 analyzer. Based on regression equations derived from the data, a correction factor for each DCA analyzer was calculated. The analyzers were recalibrated and retested for bias. RESULTS At baseline, the mean bias (range) was -0.5229 (+0.1 to -1.3) for Analyzer 1 and -0.5348 (0.0 to -1.6) for Analyzer 2. After recalibration, the mean bias (range) was 0.000 (+0.6 to -0.6) and 0.0003 (+0.5 to -0.5) for Analyzers 1 and 2, respectively, and the systematic negative bias seen prior to the calibration was almost eliminated. CONCLUSIONS We recommend periodic recalibration of POC analyzers to eliminate systematic unidirectional bias and to harmonize results between the POC and central laboratory analyzers within a healthcare system. Calibration may need to be repeated with any change in the reagent lot.
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Affiliation(s)
- Samir Malkani
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Wood JR, Kaminski BM, Kollman C, Beck RW, Hall CA, Yun JP, Cengiz E, Haller MJ, Hassan K, Klingensmith GJ, Tamborlane WV. Accuracy and precision of the Axis-Shield Afinion hemoglobin A1c measurement device. J Diabetes Sci Technol 2012; 6:380-6. [PMID: 22538150 PMCID: PMC3380782 DOI: 10.1177/193229681200600224] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Afinion HbA1c (Axis-Shield) is a newer point-of-care device for measurement of hemoglobin A1c (A1C) using a boronate affinity method unlike the more commonly used DCA immunoassay method (Siemens Medical Solutions Diagnostics). The Afinion's accuracy and precision, when compared with high-performance liquid chromatography (HPLC) and DCA methods, have not been established in pediatric practice settings. METHODS Capillary blood was collected from 700 subjects with diabetes mellitus at seven Pediatric Diabetes Consortium sites. Each subject's A1C was measured locally using Afinion and DCA devices, and by a central laboratory (University of Minnesota) using a Tosoh HPLC method. In addition, repeated measurements on six whole blood samples provided by the National Glycohemoglobin Standardization Program (NGSP) were taken at three clinical centers using the Afinion and DCA methods and centrally using the Tosoh HPLC method to assess the precision of each device. RESULTS The coefficient of variation for measurements of whole blood samples for precision analysis was 2% for Afinion, 3% for DCA, and 1% for HPLC. In the patient samples measured at the seven clinic sites, the Afinion generated higher A1C results than the HPLC (mean difference = +0.15; p < 0.001), while the DCA produced lower values (mean difference = -0.19; p < 0.001). The absolute differences with HPLC were similar for the Afinion and DCA (median 0.2%) with a slight advantage for the Afinion when compared with DCA (p < 0.001 by rank test). The DCA tended to read lower than HPLC, particularly at high A1C levels (p < 0.001), while the Afinion's accuracy did not vary by A1C. CONCLUSIONS When compared to the central laboratory HPLC method, the differences between the results of the Afinion and DCA devices are clinically insignificant, and the Afinion and DCA have similar accuracy and precision when used in pediatric practice settings.
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Affiliation(s)
- Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, California, USA.
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