PMID- 30591312 OWN - NLM STAT- MEDLINE DCOM- 20200929 LR - 20221207 IS - 1036-7314 (Print) IS - 1036-7314 (Linking) VI - 32 IP - 6 DP - 2019 Nov TI - Are point-of-care measurements of glycated haemoglobin accurate in the critically ill? PG - 465-470 LID - S1036-7314(18)30237-6 [pii] LID - 10.1016/j.aucc.2018.11.064 [doi] AB - INTRODUCTION: Critically ill patients with type 2 diabetes mellitus (T2DM) and chronic hyperglycaemia may benefit from a more liberal approach to glucose control than patients with previously normal glucose tolerance. It may therefore be useful to rapidly determine HbA1c concentrations. Point-of-care (POC) analysers offer rapid results but may be less accurate than laboratory analysis. AIM(S): The aim of this study was to determine agreement between POC and laboratory HbA1c testing in critically ill patients with T2DM. METHODS: Critically ill patients with T2DM had concurrent laboratory, capillary-, and arterial-POC HbA1c measurements performed. Data are presented as mean (standard deviation) or median [interquartile range]. Measurement agreement was assessed by Lin's concordance correlation coefficient, Bland-Altman 95% limits of agreement, and classification by Cohen's kappa statistic. RESULTS: HbA1c analysis was performed for 26 patients. The time to obtain a result from POC analysis took a median of 9 [7, 10] minutes. Laboratory analysis took a median of 328 [257, 522] minutes from the time of test request to the time of report. Lin's correlation coefficient showed almost perfect agreement (0.99%) for arterial- vs capillary-POC and both POC methods vs arterial laboratory analysis. Bland-Altman plots showed a mean difference of 2.0 (3.7) with 95% limits of agreement of -5.4 to 9.3 for capillary vs laboratory, 1.6 (3.4) and -5.1 to 8.4 for arterial vs laboratory, and -0.137 (2.6) and -5.2 to 4.9 for capillary vs arterial. Patient classification as having inadequately controlled diabetes (>53 mmol/mol) showed 100% agreement across all tests. CONCLUSIONS: HbA1c values can be accurately and rapidly obtained using POC testing in the critically ill. CI - Copyright (c) 2018 Australian College of Critical Care Nurses Ltd. All rights reserved. FAU - Weinel, Luke M AU - Weinel LM AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: luke.weinel@sa.gov.au. FAU - Summers, Matthew J AU - Summers MJ AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: matthew.summers@sa.gov.au. FAU - Finnis, Mark E AU - Finnis ME AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: Mark.finnis@sa.gov.au. FAU - Poole, Alexis AU - Poole A AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: alex.poole@adelaide.edu.au. FAU - Kar, Palash AU - Kar P AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: p_kar@hotmail.com. FAU - Chapman, Marianne J AU - Chapman MJ AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia; NHMRC Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia. Electronic address: marianne.chapman@sa.gov.au. FAU - Deane, Adam M AU - Deane AM AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. Electronic address: adam.deane@mg.org.au. FAU - Ali Abdelhamid, Yasmine AU - Ali Abdelhamid Y AD - Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. Electronic address: yasmine.aliabdelhamid@mh.org.au. LA - eng PT - Journal Article DEP - 20181224 PL - Australia TA - Aust Crit Care JT - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JID - 9207852 RN - 0 (Glycated Hemoglobin A) MH - *Critical Illness MH - Diabetes Mellitus, Type 2/*blood MH - Female MH - Glycated Hemoglobin/*analysis MH - Humans MH - Hyperglycemia/*blood MH - Male MH - Middle Aged MH - *Point-of-Care Testing MH - Prospective Studies MH - Reproducibility of Results MH - Time Factors OTO - NOTNLM OT - Critical illness OT - Glycaemic control OT - Glycated haemoglobin OT - Personalised medicine OT - Point of care OT - Type 2 diabetes EDAT- 2018/12/29 06:00 MHDA- 2020/09/30 06:00 CRDT- 2018/12/29 06:00 PHST- 2018/10/02 00:00 [received] PHST- 2018/11/13 00:00 [revised] PHST- 2018/11/16 00:00 [accepted] PHST- 2018/12/29 06:00 [pubmed] PHST- 2020/09/30 06:00 [medline] PHST- 2018/12/29 06:00 [entrez] AID - S1036-7314(18)30237-6 [pii] AID - 10.1016/j.aucc.2018.11.064 [doi] PST - ppublish SO - Aust Crit Care. 2019 Nov;32(6):465-470. doi: 10.1016/j.aucc.2018.11.064. Epub 2018 Dec 24.