ESPE Abstracts

Background: The COVID-19 pandemic has resulted in rapid implementation of tele-clinics; patients have frequently missed routine point-of-care HbA1c testing, vital for evaluating long-term glycaemic control. We evaluated the feasibility of remote HbA1c monitoring via self-collection of capillary blood samples at home, and examined clinical characteristics associated with engagement with this system.

Methods: Bio-Rad Haemoglobin Capillary Collection System (HCCS) was used. Relation between capillary and venous samples is linear (r = 0,998 y = 1,0 x + 0,0 (manufacturer’s manual). The kit’s performance was tested at the Chemical Pathology Laboratory at Royal London Hospital. 100 participants were recruited from paediatric diabetes clinics at 2 sites in East London (age 4-19, Pre-Covid HbA1c: 29-120mmol/mol). Home kits for self-collection of capillary samples were mailed out with step-by-step instructions containing pictures and a video demonstration link, and a prepaid envelope for sample return. Feasibility was assessed by examining the rate of sample return and duration taken for lab to receive sample. A usability survey addressing the home collection process and experience with the kit was emailed to families who had been sent a home HbA1c kit, consisting of 7 questions on a 5-point Likert scale to assess ease of use and preferences around HbA1c monitoring.

Results: Completion rate was 58%. Mean time taken from kit being mailed out to sample analysis was 15.6 ± 9.8 days (median 13.5). Pre-covid HbA1c was higher in the group that failed to return a sample, as compared to the group that did (65.3 ± 20.1 vs 56.8 ± 14.7 mmol/mol, P < 0.05). Overall, HbA1c remained relatively stable over the pandemic in the completion group (T1DM (n = 41) HbA1c 60.1 ± 8.8 to 57.1 ± 8.8, P > 0.05, T2DM (n = 8) HbA1c 56.4 ± 28.8 to 52.4 ± 17.3, P > 0.05). A higher proportion of non-T1DM patients had an increase in HbA1c over the pandemic (T1DM (n = 41): 49%, T2DM (n = 8): 63%, Other (n = 5): 80%). Usability scores were high: 96% found it easy to learn capillary blood sample collection, and 89% found this system very convenient.

Conclusion: Self-collection of capillary blood samples at home appears feasible to remotely assess HbA1c for patients with relatively stable glycaemic control and good engagement with their care. Routine telemedicine appointments could be suitable and convenient for these patients, if data from their devices are shared. Future work should focus on improving processes to allow for HbA1c level to be available prior to the telemedicine appointment, and assessing and removing hurdles for engagement to increase completion.