Self-testing of HbA1c feasible in diabetic patients

Patients with diabetes show high levels of acceptance and ability to adopt self-testing of glycated haemoglobin (HbA1c) despite facing issues in the insertion of test cartridges into the analyser, reports a study. Patients also express willingness to do self-testing in the future if such a service is available.

“All of them were able to perform the test themselves based on the instructions provided and willing to recommend this option of measuring glycated haemoglobin to others,” said lead author Dr Sharon Siew May Fan from SingHealth Polyclinics, Singapore, Singapore.

“This study has proven the possibility of having a self-testing HbA1c facility in our primary healthcare setting to cope with increasing demand for phlebotomy services,” she added.

Fan and her team recruited 30 eligible diabetic patients in Tampines Polyclinic. They showed participants a demonstration video before self-testing with a Point-of-Care HbA1c analyser. The patients then completed a questionnaire after the self-testing.

The System Usability Scale (SUS) was used to assess the usability of the system, while a five- or six-point Likert scale was used to measure acceptance and ability levels. Finally, the researchers utilized the Fisher’s exact test to examine the association with SUS score.

Of the participants (mean age 61.4 years), 60.0 percent were males, 50.0 percent were Chinese, and 80 percent had highest qualification of secondary education and beyond. Their mean SUS score was 66.5, and their average time to complete HbA1c self-testing was 11.8 min. Of note, demographics showed no significant association with the SUS score. [Proc Singap Healthc 2024;doi:10.1177/20101058241257264]

Nearly half of the participants (40.0 percent) had some difficulty with inserting the cartridge into the analyser, but all of them succeeded in understanding and following the video demonstration. They also expressed willingness to perform self-testing in the future instead of undergoing the conventional HbA1c testing done by the phlebotomist or medical laboratory technologist.

“With reduced reliance on the MLTs to perform their HbA1c tests, diabetic patients will not face the frustration of not being able to book an appropriate lab appointment slot prior to their regular review medical consultation,” Fan said.

“There will be a potential increase in laboratory capacity too, when the MLTs are freed up to focus on providing phlebotomy services for other tests,” she added.

“Moreover, the potential to scale up such health service beyond primary care setting to general practitioner clinics will enable outreach to a wider population and ensure a more convenient and timely process for diabetic management,” Fan said.

Gold standard

HbA1c is the gold-standard test for monitoring glycaemic control and is also one of the most-ordered laboratory tests in primary care clinics, which account for 17 percent of total laboratory service, according to the researchers.

In Singapore, 6.9 percent of residents have a diabetes diagnosis, and such incidence is expected to rise by 26.1 percent. On the other hand, the prevalence of diabetes is projected to increase by nearly 20 percent in 2030. [https://diabetesatlas.org/; https://www.moh.gov.sg/news-highlights/details/speech-by-mr-ong-ye-kung-minister-for-health-at-world-diabetes-day-2021]

“More resources are needed for the management of diabetic patients ascribed to initiatives such as ‘beyond hospital to community’, allowing patients with cross-institution laboratory orders to access phlebotomy services in primary care clinics, and the launch of ‘Healthier-SG’ advocating preventive health,” Fan said. [https://www.healthhub.sg/live-healthy/1498/towards-a-better-state-of-health; https://www.healthiersg.gov.sg/enrolment/benefits/]