Implementation of A1C Point-of-Care Testing: Serving Under-Resourced Adults With Type 2 Diabetes in a Public Health Department

Abstract

IN BRIEF A1C point-of-care testing (POCT) paired with face-to-face education potentially improves glycemic control in under-resourced populations. In this study, A1C POCT was implemented with same-day face-to-face medication management and education for adults with type 2 diabetes in a public health department in southeastern North Carolina. The combination of POCT, medication management, and education provided together improved glycemic control and decreased clinical inertia in a setting in which access to health care is limited.

FIGURE 1.

Progression of conveniently sampled participants from baseline through PI1 and final sample (PI2) that progressed through all time points.

FIGURE 2.

Percentage of participants with hypertension, hyperlipidemia, obesity, microalbuminuria, nicotine dependence, chronic kidney disease, and/or heart disease for patients with an A1C >7% and a diagnosis of type 2 diabetes at baseline. CKD I-III, chronic kidney disease stages 1–3; smoking status, current smoker.

FIGURE 3.

Classes of medications used (started/increased) by patients who received A1C POCT and had an A1C >7% at all time points. GLP-1s, GLP-1 receptor agonists.

FIGURE 4.

A one-way repeated ANOVA was used to compare the mean A1C for all patients with an A1C >7% before implementation of A1C POCT (baseline), at the initial A1C POCT (PI1), and at the 3-month follow-up A1C POCT (PI2). A significant increase in A1C was seen from baseline to PI1 (P = 0.008), and a significant decrease in A1C was seen from PI1 to PI2 (P = 0.008).

FIGURE 5.

χ2 Test used to analyze pattern of medication intensification for the implementation group at baseline, PI1, and PI2. Significant increases in medication intensification were found from baseline to PI1 and from baseline to PI2, P = 0.008 and P <0.001, respectively.