Point-of-care testing for diabetes management in Papua New Guinea

Introduction: Estimates from the latest IDF Atlas report a diabetes prevalence of 12.9% in Papua New Guinea, with 507,900 known diabetes cases and a further 265,000 undiagnosed. The first PNG Diabetes Clinical Practice Guidelines (2012) recommend regular HbA1c testing for monitoring glycaemic control. However, in 2012, HbA1c testing was only available at the Port Moresby Hospital, requiring diabetes patients from Morobe Province to travel over 300 kilometres by plane or boat to have an HbA1c test. In 2013, in partnership with the local Government and National Department of Health, point-of-care testing (POCT) for HbA1c and urine ACR was introduced to four Morobe health services under the ACE Program, an international POCT model for diabetes management.Aims: To introduce POCT for diabetes screening to reduce the number of undiagnosed patients and improve diabetes management in Morobe Province.Methods: Patients attending diabetes clinics accessed HbA1c and urine ACR POCT as part of the quality-assured ACE Program. Patients who had repeat HbA1c testing during 2013-2016 were assessed to determine their change in glycaemic control.Results: 1504 HbA1c and 621 urine ACR tests were performed on 1096 patients. 44% of patients (n=480) had diabetes. Their mean HbA1c was 9.4%. A third of patients (n=154) had repeat HbA1c testing and their mean HbA1c fell significantly from 9.2% (first measurement) to 8.6% (most recent measurement). The average time between tests was 16 months. The number of diabetes patients achieving target glycaemia (HbA1c ≤7.5%) nearly doubled (from 35 to 64), while the number of patients with poor or very poor glycaemic control (HbA1c >8.5%) decreased by a third (from 84 to 61). At one clinic where screening was a particular focus, 64% (n=43) of patients screened were newly identified with diabetes. The mean HbA1c in these new patients who had repeat testing (n=13) fell significantly from 10.5% to 8.5%. A trend towards increasing HbA1c with worsening kidney function was observable in diabetes patients who had HbA1c and urine ACR testing in the one visit (n=301). The mean HbA1c was 9.2% for diabetes patients with normoalbuminuria, 9.5% for patients with microalbuminuria and 9.8% for patients with macroalbuminuria. Quality control for both HbA1c and urine ACR met the recommended performance goals for these tests.Conclusion: POCT has promoted change in clinical practice by facilitating greater accessibility to HbA1c testing. It is likely that, due to its success, the program will be extended to health services in neighbouring communities.