This work is the first in the MENA region to explore diabetic patient satisfaction with HbA1c on-site POCT and its effect on glycemic control. Our results showed that the implementation of on-site POCT service improved patient compliance to the requested HbA1c tests in most of the included patients. We also reported a statistically significant reduction in the HbA1c level after POCT service introduction compared to the era of traditional laboratory testing. These results were in agreement with the study conducted in the Stark Diabetes Center at the University of Texas by Petersen et al., 2007. They reported that, within 6 months of POCT implementation, the average HbA1c for patients seen in the Stark Diabetes Center significantly improved and continued to decrease over time till the end of the study (compared to another center without POCT service) . Furthermore, the recent US primary-care quality improvement study showed that testing the HbA1c using POCT was 3.7 times less likely to miss HbA1c testing during the visit compared to practices that did not have POCT .
Further studies have demonstrated the beneficial effect of POCT for HbA1c testing for improving diabetes management and glycemic control. In a US trial with 597 people with T2DM visiting the primary care clinic, rapid availability of HbA1c results was associated with a decrease in the HbA1c level and improved the frequency of DM treatment intensification . As the authors emphasize, having HbA1c test results available quickly allows for the identification of patients with diabetes with adequate metabolic and glycemic control and, as a result, reduces the risk of hypoglycemia from improper therapy escalation. On the other hand, in the UK cohort feasibility study, Hirst and colleagues did not report any significant difference in HbA1c at the end of the study compared with the baseline value, which was justified by the small sample size .
To evaluate the potential effects of on-site POC for HbA1c testing in a primary care setting, data by Sølvik et al. were collected 3 months and 6 months before POCT implementation, and the same after POCT implementation. Authors reported that a high level of adherence to guideline-compliant HbA1c testing frequency by healthcare providers increased from 68.3% and 65.9% (3 months and 6 months before implementation) to 82.9% and 95% (3 months and 6 months after implementation) . These data were in agreement with our results, in which we observed that a higher level of adherence to guideline-compliant HbA1c testing frequency by physicians or diabetic educators increased from 24% (12 months before POCT implementation) to 85% (12 months after POCT implementation). As stated by the ADA, the implementation of POCT for HbA1c testing provides an opportunity for more timely treatment modifications for patients with non-controlled diabetes . The prompt handling of HbA1c results provided by the POCT avoids the patient with diabetes being affected by the turnaround time consumed by the laboratory service for testing and reporting . This delay can affect the proper timing of intensification/modification of the treatment plan and reduce patient adherence to medical therapy . Besides, good glycemic control is a substantial step to delay or prevent complications and end-organ damage associated with diabetes .
Further to the positive impact of the POCT on glycemic control, it also reports an increased patient satisfaction towards the provided healthcare services. In the present study, patients showed a high level of satisfaction on the seven dimensions of the PSQ-18 questionnaire towards the provided healthcare services at the Diabetes Treatment Centre of PSMMC after POCT implementation for HbA1c testing. Patient gender, type of diabetes, and place of residence (in Riyadh, the capital city, or outside Riyadh) did not affect the level of satisfaction among the included patients. Patients with diabetes also showed high levels of agreement and satisfaction on the HbA1c-POCT satisfaction questionnaire.
The results of a large randomized controlled trial assessing the extent of POCT in Australian medical practices showed that patients randomized to POCT reported a higher level of satisfaction and more confidence in the medical process and enhancement in patient relationship with their physician . The prompt availability of HbA1c results permits face-to-face discussion between doctor and patient, thus improving patient–doctor communication, the decision-making process, and overall patient satisfaction . Furthermore, lower patient revisits linked to POCT implementation may also contribute to higher patient satisfaction. Implementation of POC testing has been shown to reduce patient revisits by up to 61% . From an economic perspective, the UK National Health Service estimated the costs for diabetes treatment around £13.8 billion/year, while in the USA, the national expenditure on diabetes care in 2013 was US $548 billion . The health expenditure on diabetes was estimated to be US $20.5 billion across the MENA region in 2017, and interestingly, it is anticipated to reach US $37.1 billion by 2045 . As per the 2017 IDF published data, KSA was ranked as the highest amongst the MENA countries in terms of health expenditure on diabetes with $13.1 billion (international dollars) . Although the unit of POCT costs more than the conventional laboratory testing, the total reduction in the financial burden associated with POCT (including patient revisits, travel costs, work absence, and time saved) will reduce healthcare costs more than the laboratory testing . According to a recently published German study , implementing POC for HbA1c testing in diabetes practices can enhance office processes and increase physician, staff, and patient satisfaction. It demonstrates a significant acceleration of evaluation processes as a result of fewer time-consuming blood samples, scheduling activities, and patient visits.
Despite the significant benefits of POCT for HbA1c testing on glycemic control and patient satisfaction in patients with diabetes, the ADA has yet to recommend POCT for the detection of prediabetes or diabetes diagnosis. Therefore, future studies should emphasize the impact of POCT on prediabetes or diabetes diagnosis. Furthermore, maintaining a balance between the advantages and disadvantages of HbA1c tests and a sustained emphasis on accuracy and cost-effectiveness will promote the usage of POCT for HbA1c testing in the treatment plan and diagnosis of patients with diabetes/prediabetes. Furthermore, maintaining the balance between the benefits and harms associated with tests, the multiple attributes of POC tests, and a continued emphasis on accuracy and cost-effectiveness will increase the use of POCT for HbA1c testing in the treatment and diagnosis of patients with diabetes/prediabetes .
The impact of POCT on glycemic control and patient satisfaction in patients with diabetes in Saudi Arabia is uncertain, and this study contributes valuable data on the use of POCT. However, our study was limited by the relatively small sample size of patients from a single site that might limit the generalizability of the study results. Moreover, we did not assess the physician satisfaction with regard to the implementation of POCT in their clinic. Therefore, a larger multicenter study is warranted to inform future health policy. Additionally, because of the nature of this study, we cannot collect the patient satisfaction data retrospectively; therefore, changes in the level of satisfaction before and after the POCT service implementation cannot be determined. Also, we did not collect the diabetes-related complications among our study population because that was beyond the scope of our study.