Point-of-care HbA(1c) testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

INTRODUCTION: Monitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA(1c)) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa. SUBJECTS: 185 adults aged 19–88 years with type 2 diabetes. MATERIALS AND METHODS: Participants recruited to this mixed methods cohort study received a point-of-care HbA(1c) test. Doctors were asked to use the point-of-care HbA(1c) result for clinical decision-making. Qualitative interviews were held with clinical staff. RESULTS: Point-of-care HbA(1c) test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA(1c), 64 mmol/mol). Medical officers reported using a combination of HbA(1c) and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA(1c) result to help with decision-making. DISCUSSION: Our results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA(1c) test result to help them make treatment decisions.