• Aurélie Affret, Luiz Henrique Maciel Griz, Eduarda Ângela Pessoa Cesse, Yuri da Silva Specht, CarvalhoEduardo Maia Freese deEMCommunity Health Department, Aggeu Magalhães Research Center, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil., and Annick Fontbonne.
• Department of Nutrition and Associated Pathologies, Institut de Recherche pour le Développement, Universités Montpellier, Montpellier, France.
• Sao Paulo Med J. 2015 Nov 1; 133 (6): 460464460-4.

Context And ObjectiveTo monitor glycemic control in diabetic patients, regular measurement of glycated hemoglobin (HbA1c) is recommended, but this can be difficult in remote places without access to laboratories. Portable point-of-care testing devices can prove a useful alternative. Our study aimed to assess the performance of one of them: A1CNow+, from Bayer.Design And SettingCross-sectional accuracy study conducted at a university hospital in Brazil.MethodsWe made three successive measurements of capillary HbA1c using the A1CNow+ in 55 diabetic volunteers, while the same measurement was made on venous blood using the hospital reference method (Vitros 5,1 FS). We used the Bland-Altman graphical method to assess the A1CNow+ in relation to the Vitros 5,1 FS method. We also evaluated clinical usefulness by calculating the sensitivity and specificity of A1CNow+ for detecting patients with HbA1c lower than 7%, which is the usual limit for good glycemic control.ResultsThe coefficient of variation between repeat testing for the A1CNow+ was 3.6%. The mean difference between A1CNow+ and Vitros 5,1 FS was +0.67% (95% confidence interval, CI: +0.52 to +0.81). The agreement limits of our Bland-Altman graph were -0.45 (95% CI: -0.71 to -0.19) and +1.82 (95% CI: +1.52 to +2.05). The sensitivity and specificity in relation to the 7% limit were respectively 100% and 67.7%.ConclusionsAlthough the A1CNow+ had good sensitivity, its accuracy was insufficient for use as a replacement for laboratory measurements of HbA1c, for glycemic control monitoring in diabetic patients.

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