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https://doi.org/10.11613/BM.2016.013

Automatic laboratory-based strategy to improve the diagnosis of type 2 diabetes in primary care

Maria Salinas ; Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
Maite López-Garrigós ; Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
Emilio Flores ; Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
Maria Leiva-Salinas ; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain
Javier Lugo ; Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
Francisco J Pomares ; Department of Endocrinology, Hospital Universitario de San Juan, San Juan de Alicante, Spain
Alberto Asencio ; Primary Care Center of Mutxamel, Alicante-San Juan Department, San Juan de Alicante, Spain
Miguel Ahumada ; Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
Carlos Leiva-Salinas ; Department of Radiology, University of Missouri, Columbia, MO, USA


Puni tekst: engleski pdf 265 Kb

str. 121-128

preuzimanja: 440

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Sažetak

Introduction: To study the pre-design and success of a strategy based on the addition of hemoglobin A1c (HbA1c) in the blood samples of certain primary care patients to detect new cases of type 2 diabetes.
Materials and methods: In a first step, we retrospectively calculated the number of HbA1c that would have been measured in one year if HbA1c would have been processed, according to the guidelines of the American Diabetes Association (ADA). Based on those results we decided to prospectively measure HbA1c in every primary care patient above 45 years, with no HbA1c in the previous 3 years, and glucose concentration between 5.6-6.9 mmol/L, during an 18 months period. We calculated the number of HbA1c that were automatically added by the LIS based on our strategy, we evaluated the medical record of such subjects to confirm whether type 2 diabetes was finally confirmed, and we calculated the cost of our intervention.
Results: In a first stage, according to the guidelines, Hb1Ac should have been added to the blood samples of 13,085 patients, resulting in a cost of 14,973€. In the prospective study, the laboratory added Hb1Ac to 2092 patients, leading to an expense of 2393€. 314 patients had an HbA1c value ≥ 6.5% (48 mmol/mol). 82 were finally diagnosed as type 2 diabetes; 28 thanks to our strategy, with an individual cost of 85.4€; and 54 due to the request of HbA1c by the general practitioners (GPs), with a cost of 47.5€.
Conclusion: The automatic laboratory-based strategy detected patients with type 2 diabetes in primary care, at a cost of 85.4€ per new case.

Ključne riječi

type 2 diabetes; HbA1c; diagnosis; preanalytical phase; test request appropriateness; costs; cost analysis

Hrčak ID:

153942

URI

https://hrcak.srce.hr/153942

Datum izdavanja:

15.2.2016.

Posjeta: 986 *