HbA1c testing overcomes screening barriers in remote communities

Type 2 diabetes

6 Jul 2015

An HbA1c-based algorithm provides a timelier and more accurate diagnosis of diabetes in Indigenous Australians living in remote areas, new research shows.

Writing in today’s MJA the authors led by Dr Julia Marley from the University of Western Australia’s Rural Clinical School say the current diagnostic test — the assessment of blood glucose levels — was inefficient, time-consuming and responsible in part for a delayed diagnosis, particularly in remote settings.

“In contrast to glucose testing, assessment of glycated haemoglobin A (HbA1c) requires no fasting. This makes it more suitable for opportunistic testing, and results in fewer missed diagnoses,” they wrote.

The team compared the use of standard glucose testing with a combination of point-of-care (POC) and laboratory HbA1c testing in a 255 Indigenous Australians aged 15 years or more who were at high risk of diabetes.

Participants were significantly more likely to receive a definitive test result within 7 days using the HbA1c test, and were more likely to be followed up if an initial result was abnormal, they found.

HbA1c tests also detected diabetes in more people than did glucose testing, with only four of the 20 participants diagnosed with diabetes identified with the glucose algorithm.

“While our results are based on small numbers, this suggests the FPG is not sufficiently sensitive as a screening test in this population,” they wrote.

“Adopting the Kimberley HbA1c algorithm may simplify the testing process in previously undiagnosed individuals and provide a timelier and more accurate diagnosis of diabetes for Aboriginal people and other high-risk remote populations in Australia and elsewhere in the world,” they concluded.

Writing in an accompanying editorial Stephen Colagiuri from the Boden Institute of Obesity, Nutrition and Exercise, at the University of Sydney said the current glucose-based protocol endorsed by the NHMRC for screening for undiagnosed diabetes was “cumbersome, time-consuming and inconvenient”.

HbA1c testing provided an opportunity to “overcome many of the barriers to implementing effective screening programs,” he said.

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