Does reviewing fasting plasma glucose results patterns before glycosylated hemoglobin testing in type-2 diabetic patients lead to better testing decision?. Issue 3 (May 2019) - Intharachuti, Wichaporn
Abstract: Aims: Glycosylated hemoglobin (HbA1c ) test for blood glucose control in type-2 diabetic patients is recommended at least once annually under the guidelines of the Thai National Health Security Office (NHSO) benefits coverage. With limited resources and capability for HbA1c testing in most primary-care providers, this study explored patterns of fasting plasma glucose (FPG) tests for proper timing of HbA1c test would increase value of the money spent. Methods: A retrospective review of laboratory findings of 4906 type-2 diabetic outpatients in two university hospitals in Thailand was conducted. Percentages of discordant results between the indexed FPG and HbA1c tests were compared between the patient groups with different FPG patterns before HbA1c testing and the control group of randomly selected cases. Results: Having HbA1c tested after two and three consecutively normal FPG tests (OO and OOO patterns) were found to have significantly less discordance than the control group (−9.6% and −15.7%). HbA1c testing after two abnormal and one normal consecutive FPG tests (XXO pattern) gained the discordant results by 24.8%. Conclusions: Some FPG patterns were more predictive of HbA1c findings than focusing on one-time FPG results. Reviewing and recognizing certain patterns of FPGs prior to taking HbA1c tests can lead to better HbA1c testing decision than randomly prescribing the tests.