Compliance of the POCT method with the fully automated method for HbA1c determination

  • Neda Milinković University of Belgrade-Faculty of Pharmacy, Department of Medical Biochemistry
  • Marija Sarić Matutinović University of Belgrade-Faculty of Pharmacy, Department of Medical Biochemistry
  • Gordana Dmitrašinović University of Belgrade-Faculty of Pharmacy, Department of Medical Biochemistry
  • Svetlana Ignjatović University of Belgrade-Faculty of Pharmacy, Department of Medical Biochemistry; University Clinical Centre of Serbia, Center for Medical Biochemistry
Keywords: HbA1c, POCT, diabetes, Deming regression

Abstract


Previous research suggests that point-of-care (POCT) determination of glycated hemoglobin (HbA1c) is a diagnostic test that can be an adequate alternative to measuring HbA1c in the laboratory. The main goal of this study was to examine the analytical characteristics of the novel INCLIX POCT method for HbA1c determination in order to test its performance before introducing this method into routine use. HbA1c is measured in a duplicate in 44 EDTA blood samples parallel on INCLIX POCT device (Sugitech, Inc.) and using automated turbidimetric immunoinhibition test on Olympus AU400 (Beckman Coulter). The within run imprecision was 7.58%, between runs imprecision was 6.63% and 6.22%, and day-to-day imprecision was 8.80% and 7.51%. Total laboratory imprecision was in agreement with those stated by the manufacturer. A statistically significant Pearson correlation coefficient was calculated (r = 0.871, P < 0.01; linear R2 = 0.757). Using Deming regression analysis, the following equation was obtained: y = -1.80 + 1.304x. Our results indicate statistically significant correlation, linear relationship, and a significant degree of compatibility between the two analyzed methods. However, the negative bias of the HbA1c values determined on the POCT analyzer compared to the Olympus AU400 was confirmed, highlighting the need to standardize the INCLIX method.

References

English E, Lenters-Westra E. HbA1c method performance: The great success story of global standardization. Crit Rev Clin Lab Sci. 2018;55(6):408-419.

Lau CS, Aw TC. HbA1c in the diagnosis and management of diabetes mellitus: An update. Diabetes Updates. 2020;6:1-4.

American Diabetes Association. Standards of medical care in diabetes–2021. Diabetes Care. 2021;44(Supplement 1):S15-S33.

Koga M, Okuda M, Inada S, Ueda S, Nakamura Y, Okumiya T, et al. HbA1c levels measured by enzymatic assay during of‑site health checkups are lower than those measured by on‑site HPLC assay. Diabetol Int. 2020;11:67-71.

Arch BN, Blair J, McKay A, Gregory JW, Newland P, Gamble C. Measurement of HbA1c in multicentre diabetes trials – should blood samples be tested locally or sent to a central laboratory: an agreement analysis. Trials 2016;17:517.

Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Performance of Point-of-Care Testing compared with the standard laboratory diagnostic test in the measurement of HbA1c in Indonesian diabetic and nondiabetic subjects. J Diabetes Res. 2020;2020:ID 2037565. doi.org/10.1155/2020/2037565

Jalali MT, Bavarsad SS, Hesam S, Afsharmanesh MR, Mohammadtaghvaei N. Assessing agreement between the three common clinical measurement methods of HbA1c. J Diabetes Metab Disord. 2020;19:273-279.

EurA1c Trial Group. EurA1c: The European HbA1c trial to investigate the performance of HbA1c assays in 2166 laboratories across 17 countries and 24 manufacturers by use of the IFCC model for quality targets. Clin Chem. 2018;64(8):1183-1192.

Standard ISO/TC 212 Clinical laboratory testing and in vitro diagnostic test systems [Internet]. [cited 2022 Jan 07]. Available from: https://www.iso.org/committee/54916.html>

Jeppsson JO, Kobold U, Barr J, Finke A, Hoelzel W, Hoshino T, et al. Approved IFCC reference method for the measurement of HbA(1c) in human blood. Clin Chem Lab Med. 2002;40:78-89.

Approved laboratories of the IFCC network laboratories for HbA1c [Internet]. [cited 2022 Jan 07]. Available from:www.ifcchba1c.net/network/approved

Weykamp C, John WG, Mosca A, Hoshino T, Little R, Jeppsson JO, et al. The IFCC reference measurement system for HbA1c: a 6-year progress report. Clin Chem. 2008;54:240-248.

Erdal GŞ, Işıksaçan N, Koşer M, Kocamaz N. Hemoglobin A1c measurement using Point of Care Testing. Istanbul Med J. 2020;21(1):37-41.

Sølvik US, Røraas TCNG, Sandberg S. Diagnosing diabetes mellitus: Performance of hemoglobin A1c point-of-care instruments in general practice offices. Clin Chem. 2013;59:1790-801.

Arnold WD, Kupfer K, Little RR, Amar M, Horowitz B, Godbole N, et al. Accuracy and precision of a Point-of-Care HbA1c test. J Diabetes Sci Technol. 2020;14(5):883-889.

Clinical and Laboratory Standards Institute. Measurement procedure comparison and bias estimation using patient samples; approved guideline - Third corrected edition. CLSI document EP09-A3. Clinical Laboratory Standards Institute, Wayne, PA, USA, 2018.

Clinical Laboratory Standard Institute. User verification of performance for precision and trueness; approved guideline - Third corrected edition. CLSI document EP15-A2. Clinical and Laboratory Standards Institute, Wayne, PA, USA, 2017.

Clinical and Laboratory Standards Institute. Evaluation of precision performance of quantitative measurement methods; approved guideline - Third corrected edition. CLSI document EP05-A2. Clinical Laboratory Standards Institute, Wayne, PA, USA, 2018.

Australasian Association of Clinical Biochemists. Guidelines for the Evaluation of PoCT Instruments. [Internet]. [cited 2022 Jan 07]. Available:

https://www.aacb.asn.au/documents/item/244

INCLIX HbA1c Test, Instruction for use (2nd revision). Sugentech Inc. Rev.No. IS108E-02/2018.08.01.

Beckman Coulter manufacturer's manual for HbA1c calibrator [Internet]. [cited 2022 Jan 07]. Available: https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/BLB00389/%25%25/EN_HbA1c_BLB00389.pdf>

Chesher D. Evaluating assay precision. Clin Biochem Rev. 2008;29:S23-S26.

European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Biological Variation Database. [Internet]. [cited 2022 Feb 02]. Available: https://biologicalvariation.eu/search?q=hba1c>

Knaebel J, Irvin BR, Xie CZ. Accuracy and clinical utility of a point-of-care HbA1c, testing device. Postgrad Med. 2015;125:91-98.

Price CP. Point of care testing. BMJ. 2001;322(7297):1285-1288.

Zhelev Z, Peters J, Rogers M, Andrews R, McDonald T, Hyde C. Accuracy and validity of HbA1c Point of Care Testing: A review of the scientific evidence and guidelines. Exeter Test Group v3. Public Health England, University of Exeter Medical School, 2020.

Hirst JA, McLellan JH, Price CP, English E, Feakins BG, Stevens RJ, et al. Performance of point-of-care HbA1c test devices: aplications for use in clinical practice - a systematic review and meta-analysis. Clin Chem Lab Med. 2017;55:167-180.

Weykamp C. HbA1c: A review of analytical and clinical aspects. Ann Lab Med. 2013;33:393-400.

Heinemann L, Freckmann G. Quality of HbA1c measurement in the practice. The German perspective. J Diabetes Sci Technol. 2015;9(3):687-695.

Ørvim Sølvik U, Risøy AJ, Kjome RLS, Sandberg S. Quality control of Norwegian pharmacy HbA1c testing: a modest beginning. J Diabetes Sci Technol. 2018;12(4):753-61.

Hersberger KE,  Botomino  A,  Mancini  M,  Bruppacher    Sequential screening for diabetes-evaluation of a campaign in Swiss community pharmacies. Pharm World Sci. 2006;28(3):171-179.  

Krass I,  Mitchell  B,  Clarke  P,  Brillant M, Dienaar R, Hughes J, et    Pharmacy diabetes care program: analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy. Diabetes Res Clin Pract. 2007;75(3):339-347. 

Fikri-Benbrahim N, Martínez-Martínez F, Saéz-Benito L, Luque BS, Corpas JPG, Moullin JC, et al. Assessment of a screening protocol for type 2 diabetes in com-munity   The  DiabNow  Study.  Diabetes  Res  Clin  Pract. 2015;108(3):e49-e52.  

Fornos-Pérez JA,  Andrés-Rodríguez  NF,  Andrés-Iglesias  JC, Luna-Cano R, García-Soidán J, Lorenzo-Veiga B, et al.  Detection  of  people  at  risk  of  diabetes  in  community  pharmacies   of   Pontevedra   (Spain)   (DEDIPO).   Endocrinol Nutr. 2016;63(8):387-396.

Barron E, Misra S, English E, John WG, Sampson M, Bachmann MO, et al. Experience of point-of-care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study. BMJ Open Diab Res Care. 2020;8:e001703.

Van Raalten F, Hiemstra YL, Keulen N, van Duivenvoorde Y, Stoecklein K, Verhagen EA, et al. Level of agreement of point-of-care and laboratory HbA1c measurements in the preoperative outpatient clinic in non-diabetic patients who are overweight or obese. J Clin Monit Comput. 2019;33:1139-1144.

Published
2022/02/19
Section
Original scientific paper