Point-of-Care A1C and Time from Test to Communication of Results in Primary Care

Abstract

Although patients with uncontrolled diabetes (A1C ≥ 9%) frequently visit their primary care physicians’ offices, their diabetes medication is not always changed or intensified at those visits, a pattern described as “therapeutic inertia.” One potential solution is the use of point-of-care fingerstick hemoglobin A1C (A1C), which provides results in minutes, rather than venous A1C, which takes days. However, point-of-care A1C is not consistently used in current practice. The authors sought to determine the effectiveness of a systematic nurse-based intervention for implementing point-of-care A1C testing among patients with uncontrolled diabetes. They conducted a before-and-after experimental trial to determine the effect of point-of-care A1C testing on therapeutic inertia in a hospital-based clinic in New York, NY, in 2024–2025. They compared the frequency of any clinical action taken and the time to communication of results to patients before vs. after intervention implementation, using chi-squared and t-tests, respectively. The study included 203 patients, of whom 40.4% were Black or African American and 38.9% were Hispanic. Systematic collection of point-of-care A1C did not change the frequency of clinical actions taken overall (79.0% pre-intervention vs. 73.8% post-intervention, P = 0.38). However, the intervention resulted in a significantly shorter time from test to communication of results to patients, compared to usual care (0.6 days vs. 7.4 days, P = 0.03). A systematic intervention to increase the utilization of point-of-care A1C is effective in facilitating faster delivery of results to patients, which enables more counseling for patients with uncontrolled diabetes during their visit.