RT Journal Article
SR Electronic
T1 Improving T2DM Detection in Primary Care–Effectiveness of Active Opportunistic Screening Using Point-of-Care Capillary HbA1c
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 5944
DO 10.1370/afm.22.s1.5944
VO 22
IS Supplement 1
A1 Chan, Linda
A1 Lam, Cindy
A1 Samuel
A1 Wong, Yeungshan
A1 Wan, Eric Yuk Fai
A1 Chao, David V K
A1 Ko, wai kit
A1 CHEN, Xiao Rui Catherine
A1 Lee, Eng Sing
A1 Ng, Wei Leik
A1 Chan, Paul Po Ling
A1 Bilney, Emma
A1 Tang, Zoe
A1 Yuen, Sam
YR 2024
UL http://www.annfammed.org/content/22/Supplement_1/5944.abstract
AB Context: In Hong Kong (HK), undiagnosed Type 2 Diabetes Mellitus (T2DM) is a significant public health concern due to citizens’ self-perceived low susceptibility as early T2DM is asymptomatic. Implementing a better public active screening strategy is crucial. Point-of-care capillary HbA1c (POC-cHbA1c) holds promise as a solution, yet randomized trials assessing its effectiveness as a T2DM screening strategy are scarce, and none have been done in HK.Objective: To evaluate the effectiveness of 2-step active opportunistic screening using POC-cHbA1c versus venous HbA1c (vHbA1c) in improving T2DM detection among at-risk primary care patients.Study Design and Analysis: A cluster randomized controlled trial was conducted in 8 General Out-Patient Clinics (GOPCs). 2-step active opportunistic screening [risk factor count (step 1) and HbA1c testing (step 2)] was performed before proceeding to a confirmatory oral glucose tolerance test (OGTT). A mixed-effects logistic regression model was employed to account for the cluster effect.Setting: 852 at-risk patients were recruited from 8 GOPCs, 2 from each of the 4 participating clusters. They were identified during primary care consultations using consecutive sampling and eligibility screening.Population Studied: At-risk patients were screened according to criteria of the International Diabetes Federation and HK Reference Framework for Diabetes Care for Adults in Primary Care.Intervention: After step 1, at-risk patients received either POC-cHbA1c testing at intervention clinics or vHbAlc testing at control clinics for step 2. Confirmatory OGTT was offered to those with preliminary HbA1c ≥5.6%.Outcome Measures: 1) Uptake rate of HbA1c testing; 2) proportion of T2DM and pre-DM detected; and 3) the number-needed-to-screen (NNS) to detect one more case with T2DM using POC-cHbA1c versus vHbA1c.Results: The uptake rate of POC-cHbA1c was higher than vHbA1c (76.0% vs 37.5%; OR=7.06, 95% CI [2.47-20.18], p<0.001). POC-cHbA1c detected proportionately more T2DM (4.2% vs 1.4%) and pre-DM (11.8% vs 6.9%) cases. There were higher odds of POC-cHbA1c detecting T2DM and pre-DM combined (OR=1.99, 95% CI [1.01-3.95], p=0.048). NNS was 61 for POC-cHbA1c to detect one more T2DM patient versus vHbA1c.Conclusions: Active opportunistic screening using POC-cHbA1c had higher uptake and overall detection rates of T2DM plus pre-DM among at-risk primary care patients compared to vHbA1c. It shows promise as an effective T2DM screening strategy.