Point-of-Care testing of HbA1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis

Awareness, treatment, and control of diabetes in South America: A systematic review and meta-analysis

Theaim of this review is to determine the proportion of awareness, treatment, and control of diabetes in the South American region. A comprehensive search was conducted using PubMed, EMBASE, SCOPUS, and LILACS databases from January 1, 2014, to March 23, 2024. We included observational, population-based studies that assessed the rates of awareness, treatment, and control of diabetes. The risk of bias was evaluated as proposed by Hoy and cols. A meta-analysis was performed using the random effects model, and heterogeneity was assessed using the I2 statistic. Additionally, a metaregression analysis was conducted to further explore heterogeneity. Fourteen studies met our eligibility criteria. The disease awareness meta-analysis, which included six studies, revealed that 71.7% (95% CI: 65.2%-77.8%, I2: 94.2%) of participants had a previous diagnosis of diabetes. The disease treatment meta-analysis, which included five studies, indicated that 64.6% (95% CI: 52.9%-75.3%, I2: 98.7%) of participants were receiving some form of treatment for diabetes, and 42.4% (95% CI: 36.0%-49.1%, I2: 96.3%) had their glycemic values within target ranges. All included studies were assessed to have a low risk of bias. In South America, the limited available evidence suggests a significant portion of individuals with diabetes remain untreated and uncontrolled. Numerous countries lack critical information on the diabetes care cascade necessary to inform health policies.

Unraveling the future: hot topics shaping molecular diagnostics today

INTRODUCTION

This special report highlights the transformative potential of advanced diagnostic technologies in modern healthcare, emphasizing their role in enhancing disease detection, treatment personalization, and patient outcomes.

AREAS COVERED

Innovations such as Next-Generation Sequencing (NGS), liquid biopsy, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) -based diagnostics, Point-of-Care (PoC) testing, microbiome analysis, and Artificial Intelligence are reshaping the diagnostic landscape. These methods facilitate early identification of diseases, enable tailored therapies based on individual genetic profiles, and provide noninvasive monitoring options. Furthermore, telemedicine enhances access to care while reducing costs associated with traditional healthcare delivery. Despite these advancements, challenges remain regarding regulatory compliance, data privacy concerns, and disparities in access to diagnostic services. The report underscores the need for ongoing collaboration among stakeholders to address these limitations effectively.

EXPERT OPINION

By prioritizing equitable access and continuously evaluating emerging technologies' impact on patient safety and health outcomes, the healthcare system can harness the full potential of modern diagnostics to improve global health.

Observational assessment of the utilization of donated point of care tests and glycemic control at free and charitable clinics across the United States

Introduction

Populations experiencing poverty often lack access to convenient lab tests. This analysis assesses trends observed from a national point of care (POC) lab donation program for free and charitable clinics across the United States.

Methods

A total of 16 clinics were selected to receive a comprehensive package of POC lab tests. De-identified data on POC test utilization and results were assessed to descriptively identify trends in utilization (primary objective) and glycemic control (secondary objective). A paired t-test was utilized to identify statistically significant changes in HbA1c from baseline to predefined 90-day time intervals for all people living with diabetes (PLWD) and those with a baseline HbA1c ≥ 9.0 % (75 mmol/mol). The main comparison of interest was the change in HbA1c from baseline to 90-179 days.

Results

A total of 17,563 POC tests were completed for 9658 patients with 3223 tests being HbA1c's. In the secondary analysis of PLWD with a baseline HbA1c ≥ 9.0 % (75 mmol/mol), patients who completed an HbA1c between 90 and 179 days (n = 188) demonstrated a statistically significant mean reduction from baseline of -1.2 % (95 % CI, -1.6 % to -0.9 %, p < 0.01, -10 mmol/mol [95 % CI, -6 mmol/mol - -14 mmol/mol]).

Discussion

The provision of POC labs helped support the care populations experiencing poverty received at free and charitable clinics, especially for chronic diseases like diabetes.

Sensitive electrochemical detection of glycated hemoglobin (HbA1c) using cobalt metal-organic framework/two-dimensional molybdenum diselenide nanocomposite-based immunosensors amplified by polyoxometalate/DNA aptamer

Clinical diagnosis and long-term diabetes management are advanced by monitoring glycated hemoglobin A1c (HbA1c) levels. New sensitive sandwich-like immunosensors for the diagnosis of early diabetes toward detecting HbA1c and hemoglobin (Hb) are demonstrated for the first time. DNA aptamers are used for signal amplification in the sensors for the detection of HbA1c and Hb. The immunosensors are constructed by coating with a cobalt-based metal-organic framework (Co-MOF)/two-dimensional molybdenum diselenide (2D MoSe2) composite onto a working electrode of an ItalSens screen-printed electrode (SPE) inserted into a Sensit/Smart Potentiostat affixed to a smartphone. After the immobilization of the antibodies, the detection is obtained by incubating the resultant SPEs in target solutions and then detecting the response of Keggin-type polyoxometalate (POM) bound on the DNA aptamer chains. In the selected potential window, the POM (silicotungstic acid, H4[α-SiW12O40]) used in this study exhibits the electron-transfer processes I and II ([α-SiW12O40]4-/5- and [α-SiW12O40]5-/6-, respectively) in the acidic buffer electrolyte. Our proposed device demonstrates exceptional performance in the recovery test of %HbA1c in healthy human plasma samples. The sensitivity, selectivity, and stability of this immunosensor are exceedingly outstanding, which makes it one of the potential analytical devices for diagnosing early diabetes by a %HbA1c assay.

Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas

While, many interventions can prevent cardiovascular disease (CVD), and its resulting morbidity or mortality, these are used sub-optimally in most countries. Therefore, health systems need to develop new approaches to ensure that proven CVD therapies are delivered widely. In this review, we describe five impactful implementation strategies which include: (1) Task shifting, (2) Use of mobile-Health (mHealth) support and virtual access to care, (3) simplified diagnostic and management algorithms for the prevention of CVD, (4) improving the use of combinations of medicines (i.e., polypill), and (5) patient engagement and role of patient-nominated peer support (i.e., treatment supporters). Adapting and tailoring these strategies to the local context in different settings in various countries in the Americas and the Caribbean can reduce the morbidity and mortality of CVD substantially.

Mobile Phone App to Promote Lifestyle Change in People at Risk of Type 2 Diabetes: Feasibility 3-Arm Randomized Controlled Trial

Background

The use of mobile health interventions, such as apps, are proposed to meet the challenges faced by preventive health care services due to the increasing prevalence of type 2 diabetes (T2D). Thus, we developed and conducted initial feasibility testing of the Plunde app for promoting and monitoring individual goals related to lifestyle change for people at risk of T2D.

Objective

The primary aim of this study was to assess the feasibility of an app for promoting lifestyle change in people at risk of T2D. The secondary aim was to assess recruitment rate, resource requirements, and change in potential outcomes for a full scale randomized controlled trial (RCT) study .

Methods

A 3-arm feasibility RCT lasting 12 weeks was designed. Participants were recruited from 9 general practitioners in Norway. Eligible participants were randomized to either (1) app follow-up; (2) app follow-up and referral to care as usual in Healthy Life Centers; or (3) referral to care as usual in a Healthy Life Center, only. The primary outcome was feasibility and was measured by app adherence (actual usage of the app), the System Usability Scale, and app motivation score gained from a questionnaire designed for this study. Criteria for success were preset based on these measures. Secondary outcomes included recruitment rate, resource requirements, and potential primary outcomes of a full-scale RCT. This included change in body weight, waist circumference, and self-evaluated functional health status, assessed with the Dartmouth Primary Care Cooperative Research Network/World Organization of Family Doctors (COOP/WONCA) functional health assessment chart.

Results

Within 8 months, 9 general practitioners recruited a total of 54 participants, of which 45 were eligble for participation in the study. Mean age was 61 (SD 13) years and 53% (n=24) were female. App adherence was 86%, the mean System Usability Scale score was 87.3 (SD 11.9), and the mean app motivation score was 74.8 (SD 30.3). Throughout the intervention period, health care professionals spent on average 3.0 (SD 1.0) minutes per participant per week providing follow-up. Statistically significant reduction in body weight and waist circumference was shown in group 1 and 3.

Conclusions

Based on the preset criteria for success, the Plunde app is feasible in providing support for lifestyle change. The Plunde app had excellent user satisfaction. The amount of time spent on monitoring and promoting lifestyle change through the app was low; however, the recruitment was slow. Results from this study will guide the development of further research within this field.

Does performing a Point-Of-Care HbA1c test increase the chances of undertaking an OGTT among individuals at risk of diabetes? A randomized controlled trial

AIMS

Early detection of type 2 diabetes mellitus is key to reducing micro and macrovascular complications associated with this disease. However, a lab-based process for diagnosis entails the risk of loss-to-follow-up. The objective of this study was to demonstrate if performing a point-of-care test of HbA1c immediately after a screening questionnaire will increase the proportion of individuals showing up for a lab-based confirmatory test as Point-of-care (POC) provides immediate availability, which is expected to reduce loss-to-follow-up.

RESEARCH DESIGN AND METHODS

This trial was a two-arm, randomized controlled, open-label study. Participants were recruited using the FINDRISC Score in a primary care and community setting. All 902 eligible participants were randomized into the intervention (n=511) and control (n=391) group. The intervention group was given information on healthy lifestyles, and a Point-of-care POC-HbA1c test was performed during the same visit. The control group was only given information on healthy lifestyles. Participants in both groups received a written prescription to have an oral glucose tolerance test (OGTT) performed within the next 30 days. Follow-up phone calls were made at 30 and 90 days to check if participant had undergone the test. The total duration of the intervention was 8 months. The posterior data analysis was made by using the Kolmogorov-Smirnoff test for the quantitative variables, and the descriptive statistics were expressed as means and standard deviation, or median and interquartile range 25 %-75 %, as appropriate.

RESULTS

At 30 days, 28 % of participants in the intervention group and 26.1 % in the control group undertook the OGTT (RD 1.90 %; 95 % CI -3.94; 7.73). At 90 days, 35.8 % of participants in the intervention group and 37.1 % in the control group undertook the OGTT. There was no statistically significant difference (RD - 3.17 %; 95 % CI -7.04; 0.70) between both groups.

CONCLUSIONS

The data suggest that performing a POC-HbA1c test after the FINDRISC did not increase the percentage of individuals showing up for the OGTT.

Implementation of point-of-care HbA1C instruments into community pharmacies: Initial development of a pathway for robust community testing

BACKGROUND

Point-of-care (POC) analysers in community settings can provide opportunistic and regular HbA1c monitoring. Community pharmacies in NHS Scotland are utilised by populations at greatest risk of type two diabetes (T2D). This study describes initial development of an HbA1c pathway using a POC analyser in community pharmacies.

METHODS

The Abbott Afinion analyser was compared in (i) NHS Tayside's Blood Sciences Service and (ii) community pharmacies from four Scottish Health Boards. A side by side comparison with standard operating procedures for HbA1c quantification using 80 T2D patient venous samples. The machine was implemented into 11 community pharmacies and 144 samples obtained from patients for comparison to their recent laboratory HbA1c. Four focus groups examined themes around the intervention and an exit questionnaire was administered.

RESULTS

Laboratory assessment verified the efficacy of the POC test machine. The value for level 1 quality control was 44 mmol/mol and the mean during testing 42.7 mmol/mol. The greatest percent coefficient of variation (cv) was within-run for both levels of quality control material, at a value of 1.63% and 1.62%, respectively. The analyser performed robustly within the pharmacy assessment, with a mean difference of 1.68 and a standard deviation of 0.71 (CV 0.423). Patients with T2D reported positive experiences of using a pharmacy. The focus groups identified an appreciation of the convenience of pharmacies and of the longitudinal relationships with pharmacy staff.

CONCLUSION

POC HbA1c analysers can be successfully established in community pharmacies. The target patient group responded positively to the opportunity to use a pharmacy service.

Advancements in magnetic nanoparticle-based biosensors for point-of-care testing

The significance of point-of-care testing (POCT) in early clinical diagnosis and personalized patient care is increasingly recognized as a crucial tool in reducing disease outbreaks and improving patient survival rates. Within the realm of POCT, biosensors utilizing magnetic nanoparticles (MNPs) have emerged as a subject of substantial interest. This review aims to provide a comprehensive evaluation of the current landscape of POCT, emphasizing its growing significance within clinical practice. Subsequently, the current status of the combination of MNPs in the Biological detection has been presented. Furthermore, it delves into the specific domain of MNP-based biosensors, assessing their potential impact on POCT. By combining existing research and spotlighting pivotal discoveries, this review enhances our comprehension of the advancements and promising prospects offered by MNP-based biosensors in the context of POCT. It seeks to facilitate informed decision-making among healthcare professionals and researchers while also promoting further exploration in this promising field of study.