SEQC Spanish Society of Laboratory Medicine

• It includes the participation of various scientific societies and seeks to offer a “global view” on carrying out these tests in different care areas

• The guide addresses the latest developments in the use of HbA1c, considering the advantages of its measurement of glucose

The term diabetes mellitus (DM) includes a group of diseases characterized by chronic hyperglycaemia. To help patients with these pathologies reduce the risk of developing chronic complications, it is important to diagnose early and regularly identify the intensity of the metabolic disorder. The most common analyses for this are the measurement of glucose and glycated haemoglobin (HbA1c), which can be carried out both in the clinical laboratory and in different environments, within what is known as laboratory tests at the patient care site, or Point-of-Care Testing (POCT).

At the present time, there is a lot of variation regarding how these analytical measurements are done, and the Spanish Society of Laboratory Medicine (SEQC^ML) considers it necessary to promote a “global vision” in relation to the measurement of glucose and HbA1c for patients with DM. That is why this scientific society has promoted the development of a consensus document, with the participation of various scientific societies representing the different professionals involved in the care of these patients.

The result of this effort is the document 'Glucose and HbA1c in the laboratory and as Point-of-Care Testing in different clinical settings', recently published, and in whose preparation have participated, in addition to the SEQC^ML, members of the Spanish Society of Diabetes (SED), the Spanish Society of Urgent and Emergency Medicine (SEMES), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Family and Community Pharmacy (SEFAC), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Endocrinology and Nutrition (SEEN), the Spanish Society of Primary Care Physicians (SEMERGEN), and the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC).

This document seeks to answer questions such as when a glucose or HbA1c determination should be requested from the clinical laboratory and when it can be done as POCT, how often the measurements should be taken, and how the results should be interpreted in each case, among other issues. New developments in this area are also included, since HbA1c has been included as a diagnostic criterion for diabetes mellitus by the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the World Health Organization (WHO). This recommendation is based on certain advantages of its measurement of glucose, such as the convenience of not requiring the patient to fast and less intra-individual variability.

Global view of the care process

“Health professionals who participate in the care of these patients can come from very different areas. The same patient can be treated in a community pharmacy, then go to a primary care consultation, a hospital emergency department, be admitted to a critical care unit, etc. To be able to offer proper health service, there should be fluid communication between all the areas involved, with a global view of the care process,” explains Dr Paloma Oliver Sáez, of the Commission on Laboratory Testing at the Point of Care (POCT) of the SEQC^ML and coordinator of the document. Dr Oliver points out that it is important for there to be a clear definition as to when the glucose or HbA1c measurement should be requested from the laboratory and when it should be carried out as POCT in the unit itself.

The document focuses especially on the POCT tests, since, in relation to these tests and in accordance with national and international guidelines, it is essential that there is a multidisciplinary group led by the laboratory to carry out the different functions that are needed to perform this type of measurement. “With this document, the various professionals have tried to advance a little more in this direction with a multidisciplinary perspective, considering the distinctive features of the measurements in the laboratory and in POCT, and also of each clinical environment, always with the focus squarely on what it unites us all, which is the health care of our patients”, says Dr Oliver.