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Original Research

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

ORCID Icon, ORCID Icon, ORCID Icon, &
Pages 41-47 | Published online: 07 Jan 2021
 

Abstract

Background/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.

Graphical Abstract

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Acknowledgments

The work was completed at Great Western Hospital. We would like to thank Miss. Chanelle Smith, Medical Student, Bristol University, UK, for her assistance with data collection during the study period and Mr. Nimish Shah, Consultant Ophthalmologist, Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, UK, for his guidance during the study period, assistance with data collection, and for providing the opportunity for close liaison with our local diabetologists.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The authors have no funding to declare.