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Office Diagnostics Improve Diabetes Health Outcomes

Point-of-care (POC) diagnostic testing in the treatment of diabetes patients improves health outcomes and results in better-managed care among the underserved, according to research presented at the recent American Academy of Family Physicians (AAFP) Scientific Assembly in Orlando, Fla.

Testing in the doctor's office allows for more immediate follow-up counseling and is more likely to prevent complications than traditional care requiring out-of-office test referrals, says the study's lead author, Vipin Jain, MD, of the Madison County Community Health Center in Anderson, Ind.

"Because of the point-of-care tools, the patients have to own their results, and the providers can take advantage of those teachable moments when the patient is right in front of them," Jain says.

Jain and his co-authors compared outcomes of 105 patients with type 2 diabetes treated at the federally qualified health center serving Anderson—where POC diagnostics tools are available—with 59 diabetes patients at the clinic's northern facility in Elwood, Ind., where patients were managed by traditional methods.

In Anderson, located about 35 miles northeast of Indianapolis, patients had access to STAT measurements for glycated hemoglobin (A1C), lipids, alanine aminotransferase (ALT), and urine microalbumin. Patients treated in Elwood were referred to a nearby hospital for testing. At both locations, the researchers tracked clinical indicators recommended by the national consensus guidelines on diabetes over 12 months.

The POC group showed 1.47% improvement in their A1C, compared with 0.83% improvement in the control group. Of the POC patients, 64.3% achieved the desired A1C level of less than 7%, compared with 28.6% of the traditional-care patients.

As for improved cholesterol levels, 63.2% of the POC group achieved LDL below 100, compared with 28.6% of the control group. Only 5% of the POC patients did not have any lipid measurements, while 42.8% of the traditional-care patients failed to have a lipid profile obtained.

Finally, blood pressure control was better achieved in the POC group, where 78.9% of patients achieved systolic blood pressure below 130 and 74.6% diastolic blood pressure below 80. In the control group, 57.1% of patients achieved desired blood pressures.

Monofilament and foot exams were performed equally among both groups, and dilated eye exam rates were similar. Data on aspirin therapy, influenza, and pneumococcal vaccination were not recorded.

Controlling blood glucose and cholesterol has been a problem among the underserved population, the study reports. A number of financial, logistical, cultural, and language barriers influence a patient's ability to obtain the laboratory tests recommended by his or her primary care provider.

Jain estimates that the testing equipment used in his study, which meets the Clinical Laboratory Improvement Amendments of 1988 requirements, can be purchased for $5,000 to $7,000.

"As providers have STAT availability of results, they can take advantage of timely intervention, make changes in medications, and help motivate the patient in active management of care," the study concludes.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beckley, E. T. Search for Related Content PubMed Articles by Beckley, E. T. Social Bookmarking                What's this?