Endocrine Abstracts

Background: Rapid implementation of tele-clinics was necessary during the COVID-19 pandemic. Patients missed routine point-of-care HbA1c testing, vital for evaluating long-term glycemic control. We evaluated the feasibility of remote HbA1c monitoring via self-collection of capillary blood samples at home, and examined clinical characteristics associated with patient engagement.

Methods: Bio-Rad Haemoglobin Capillary Collection System (HCCS) was used, with kit performance tested at the Chemical-Pathology Laboratory at Royal London Hospital. 100 participants were recruited from paediatric diabetes clinics at 2 East London sites (4-19y, Pre-Covid HbA1c:29-120mmol/mol). Home kits for capillary sample self-collection were mailed out with step-by-step instructions and video demonstration links, with a prepaid envelope for sample return. Feasibility was assessed by the rate of sample return and time taken for sample arrival at the laboratory. A usability survey addressing the home collection process and user-experience was emailed to all families, 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 duration 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: 60.1±8.8 to 57.1±8.8, P>0.05, T2DM: 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 is a feasible option to remotely monitor HbA1c in patients with stable glycemic control and good prior engagement with their care. Routine telemedicine appointments could be suitable and convenient for these patients, utilising data from their continuous monitoring devices. Future work would improve processes such that HbA1c level is regularly available prior to the telemedicine appointment, and to assess and remove hurdles for engagement to increase completion.