科研之友
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摘要
Objectives: To determine whether a combination of point-of-care (POC) and laboratory glycated haemoglobin A (HbA(1c)) testing (HbA(1c) algorithm) is more effective in testing for diabetes in everyday practice in remote Australian Aboriginal primary health care, by providing a more rapid definitive result and diagnosing more cases than the standard glucose algorithm. Design: Cross-sectional study that independently classified participants using both diagnostic algorithms and compared their outcomes. Participants: Two hundred and fifty-five Aboriginal Australians aged 15 years or more without confirmed diabetes and due for diabetes testing at participating clinics. Setting: Six primary health care sites in the Kimberley region of Western Australia from 1 September 2011 to 30 November 2013. Main outcome measures: Number of participants with a definitive test result, a completed algorithm and a diagnosis of diabetes; time taken to deliver a test result. Results: Participants were significantly more likely to have a definitive result within 7 days (249 v199 of 255 participants; P<0.001), be followed up if an initial laboratory measurement was abnormal (92 v 74 of 167 participants; P=0.005), and be diagnosed with diabetes (15 v 4 of 255 participants; P=0.003) using the HbA(1c) than with the glucose algorithm. Eight participants subsequently diagnosed with diabetes (four using the HbA(1c) test, four with additional oral glucose tolerance tests that would not normally have been requested) were incorrectly classified as normal by the glucose algorithm. No participants with normal HbA(1c) measurements were subsequently diagnosed with diabetes. Conclusions: Use of POC HbA(1c) testing and collection of venous blood on the same day for a confirmatory laboratory HbA(1c) testing if the POC HbA(1c) value is abnormal may simplify diabetes testing in remote areas, provide more timely diagnoses, and increase case detection.
- 出版日期2015-7-6
