The utility of point-of-care haemoglobin A1c tests in a very remote Aboriginal and Torres Strait Islander community: an agreement analysis with routine laboratory testing

Introduction: Optimal blood glucose control is critical to the prevention of diabetes complications.Point-of-care testing (POCT) provides a flexible alternative to conventional approaches that rely on laboratory processing of venous blood samples, with variable time to receiving results.We determined the level of agreement between the A1CNow+ glycated haemoglobin POCT system and routine laboratory haemoglobin A1C (HbA1c) testing in a remote Aboriginal Australian community.Methods: HbA1c was measured in Aboriginal and Torres Strait Islander adults using capillary blood and the point-of-care device and venous blood using standard laboratory procedures.Agreement between the point-of-care and laboratory results was examined using a modified Bland-Altman analysis and diagnostic agreement for type 2 diabetes using Cohen's kappa coefficient.Capillary and venous blood collection were conducted in a clinical setting.Results: Participants (n=49) were on average age of 43±10 years, 65% were female, and with mean BMI of 30±5 kg/m .Median HbA1c was 5.7% (39 mmol/mol) for both methods of measurement.The mean difference between the A1CNow+ point-of-care test and laboratory HbA1c measurement was 0.03% (0.34 mmol/mol), with limits of agreement of -0.75 to 0.81% (-8.15-8.83mmol/mol).Diagnostic agreement for type 2 diabetes (HbA1c ≥6.5% (48 mmol/mol)) was moderate (Cohen's kappa statistic 0.70), with minor discrepancies observed at higher HbA1c levels.Discussion: These findings support the clinical usefulness of portable HbA1c point-of-care testing beyond traditional clinic settings.While clinic-based models have improved diabetes care, they do not reach all remote communities effectively.Home-based outreach health care utilising A1CNow+ point-of-care testing may improve access to care, strengthen family engagement, and reduce cultural and logistical barriers.Despite sparse data at HbA1c levels greater than 55 mmol/mol, overall benefits appear meaningful.Conclusion: Capillary measurement of HbA1c using a portable point-of-care device demonstrated promising agreement with routine laboratory-tested venous blood HbA1c.This supports the development of novel outreach models of diabetes care that meet remote Aboriginal and Torres Strait Islander community needs.