The utility of point-of-care HbA1c tests in a very remote Aboriginal and Torres Strait Islander community: an agreement analysis with routine laboratory testing

Early Abstract:

Introduction: Optimal blood glucose control is critical to the prevention of diabetes complications. Point-of-care testing provides a flexible alternative to conventional approaches that rely on laboratory processing of venous blood samples, with variable time to receiving results. We determined the level of agreement between the A1CNow+ glycated haemoglobin point-of-care testing system (People Technology Services (PTS) Diagnostics, USA) and routine laboratory Haemoglobin A1C (HbA1c) testing in a remote Aboriginal Australian community. 
Methods: HbA1c was measured in Aboriginal and Torres Strait Islander adults using capillary blood and the point-of-care device and venous blood using standard laboratory procedures. Agreement between the point-of-care and laboratory results was examined using a modified Bland-Altman analysis and diagnostic agreement for Type 2 diabetes (T2D) using Cohen’s kappa coefficient. Capillary and venous blood collection was conducted in a clinical setting. 
Results: Participants (n=49) were on average 43±10 years old, 65% were female, and with mean body mass index of 30±5 kg/m2. Median HbA1c was 5.7% (39 mmol/mol) for both methods of measurement. The mean difference between the A1CNow+ point-of-care test and laboratory HbA1c measurement was 0.03% (0.34 mmol/mol), with limits of agreement of -0.75 to 0.81% (-8.15 to 8.83 mmol/mol). Diagnostic agreement for T2D (HbA1c ≥ 6.5% (48 mmol/mol) was moderate (Cohen’s kappa statistic 0.70), with minor discrepancies observed at higher HbA1c levels.
Discussion: These findings support the clinical usefulness of portable HbA1c point-of-care testing beyond traditional clinic settings. While clinic-based models have improved diabetes care, they do not reach all remote communities effectively. Home-based outreach health care utilising A1CNow+ point-of-care may improve access to care, strengthen family engagement, and reduce cultural and logistical barriers. Despite sparse data at HbA1c levels above 55 mmol/mol, overall benefits appear meaningful. 
Conclusion: Capillary measurement of HbA1c using a portable point-of-care device demonstrated promising agreement with routine laboratory-tested venous blood HbA1c. This supports the development of novel outreach models of diabetes care that meet remote Indigenous community needs. 
What is already known on this subject: 
-    Point-of-care testing (POCT) for haemoglobin A1c (HbA1c) has been used in remote Northern Territory (NT) health clinics to manage diabetes in Aboriginal and Torres Strait Islander patients through the national Quality Assurance in Aboriginal and Torres Strait Islander Medical Services (QAAMS) Program. 
-    Supporting diabetes care in remote Northern Territory communities requires models of care that align with community priorities and preferred ways of engaging with healthcare. Smaller, portable POCT devices may facilitate outreach-based care and warrant further validation.
What this paper adds: 
-    Our analysis shows high acceptability and promising agreement between the portable PTS Diagnostics A1CNow + POC testing and routine laboratory blood HbA1c testing when used in a remote Aboriginal community in Northeast Arnhem Land, NT. 
-    These results support the development of novel models of home-based care and prevention for diabetes and related chronic diseases.