Current Position Information
Geriatric Medicine Fellow, UCLA Health, Los Angeles, California
Scholarly Research Project
Improved Control of Type 2 Diabetes Mellitus in a Primary Care Population Using Point-of-Care HbA1C Testing
Rahul Ahuja, DO; Alan Finkelstein, MD
In 2017, UPMC Shadyside Family Health Center (SFHC) monitored 601 patients with Type 2 Diabetes (T2DM) through HbA1C values by drawing patient blood and sending it to an outside lab for testing. Previous research has shown that sending patients for lab testing and telephoning them once results are available leads to delay in treatment. Even with in-office phlebotomy, delays in treatment adjustment are likely because many doctors prefer to wait until the next office visit to discuss therapy escalation since it involves increasing dosages, adding medications, and perhaps advancing to insulin.
In the pre-intervention phase, patients’ HbA1C values were checked via venipuncture. We performed a 3-month chart analysis to determine the rate of escalation of anti-hyperglycemic therapy and time taken to escalate such therapy (solely including medication addition and/or dose escalation). The intervention involved initiating HbA1C testing with a POC machine at SFHC. Post-intervention, another 3-month chart review of T2DM patients was performed. We then compared rates of treatment escalation and time taken to treatment intensification to the pre-intervention phase.
The rate of anti-hyperglycemic escalation was 8.8% in the pre-intervention phase compared to 21.3% post-intervention (p<.05).
The average time to intensify anti-hyperglycemic therapy in the pre-intervention phase was 23.2 days (range 1 – 96 days) compared to 1 day (range 0 to 10 days) in the post-intervention phase (p<.05).
The availability of real-time HbA1C data in the primary care setting, through POC testing, increased rates of anti-hyperglycemic therapy escalation when indicated, and reduced time to treatment intensification.