RHAM - Phase 3
Research type
Research Study
Full title
Remote HbA1c monitoring (RHAM) using dried blood spot sample collection – Phase 3
IRAS ID
246351
Contact name
Sandra MacRury
Contact email
Sponsor organisation
University of the Highlands and Islands
Duration of Study in the UK
0 years, 6 months, 30 days
Research summary
Research Summary
Five per cent of the Scottish population is registered as having diabetes. Good blood glucose control is essential for effective management of diabetes and is monitored by regular testing of HbA1c. In NHS Highland patients requiring HbA1c tests attend their GP practice for venepuncture, with blood samples sent to Raigmore Hospital for analysis. This project aims to provide a more convenient and acceptable method of blood sample collection especially for rural dwellers: dried blood spots prepared by the patient at home using capillary blood.The project builds on two previous phases of the study which demonstrated a favourable (strong) correlation between venous and capillary dried blood spot HbA1c levels and high acceptability of the intervention in participants who were undertaking home-based monitoring.
PHASE 1 (completed) involved semi-structured interviews with patients attending urban (Inverness) and peripheral (Skye) diabetes clinics to ascertain views on the dried blood spot and HbA1c self-testing approach. In PHASE 2 (completed) participants attending routine clinics in Inverness were asked to prepare dried blood spots in clinic and at home and return these by post to Raigmore Hospital for analysis. Results were compared with venous samples taken at the routine clinic. A questionnaire assessed participants’ views on ease of use and acceptability after completion and return of dried blood samples.
PHASE 2 examined the views of users who routinely carry out SMBG as part of their diabetes management. However, the majority of people with diabetes are community managed and not regularly carrying out SMBG. Given those patients’ unfamiliarity with SMBG, it is important that their views on acceptability of home-based DBS sampling are explored. Therefore, PHASE 3 of this project will seek opinions from people with diabetes who are managed in the community (and who are not regularly carrying out SMBG) and from staff in GP practices.
Summary of Results
We would like to thank all the participants who contributed their time to taking part in the study. The research was carried out by Professor Sandra MacRury, Dr Ania Zubala and Dr Jenny Hall from the Rural Health and Wellbeing division at the University of the Highlands and Islands. The University of the Highlands and Islands sponsored the study, and the study took place in the NHS Highland Health Board area between 2019 and 2022.
The research was needed to help with understanding whether and how the HbA1c testing service in NHS Highland could be redesigned to enable better use of HbA1c results.
HbA1c is a measure of blood glucose control in diabetes. In Highland, people with diabetes are expected to visit their GP every six months to have a venous blood sample taken and sent to a central laboratory in Inverness for HbA1c analysis. Results are used to assess blood glucose control and to support decision making with their clinician on any lifestyle or medication changes. HbA1c results are often not available when people attend diabetes appointments. This means that decisions may be made without all the information that could be available.
In a previous study, we worked with people with diabetes who attended diabetes clinics at Raigmore Hospital, Inverness. Hospital diabetes clinics tend to be for people with either type 1 or complicated type 2 diabetes. These people regularly carry out blood glucose testing where they obtain a drop of blood from their finger using a lancet. We asked people about the use of an alternative method of blood sample collection: dried blood spots (DBS) prepared by patients at home using capillary blood from a finger prick made using a lancet. Participants in that study indicated that the use of DBS would be an acceptable alternative and that they would be more likely to have their HbA1c test done this way.
Most people with diabetes in Highland have type 2 diabetes and are likely to go to their GP practices for diabetes appointments.
People with type 2 diabetes don’t routinely test their blood glucose levels. This means that they are not usually familiar with the use of lancets to obtain drops of capillary blood from a finger.
The current research was carried out to extend our understanding on how the use of DBS is viewed by people whose type 2 diabetes is managed by their GP practice.
The main questions studied were:
Is a DBS service for HbA1c testing an acceptable alternative to having blood taken at a GP practice?
What issues or challenges might there be for patients with introducing a DBS service for HbA1c testing?
Do patients think that it is useful to give further information about HbA1c as part of the DBS service for HbA1c testing?
Four GP practices agreed to take part in the study and sent study packs to people in their practices who were eligible to take part. Study packs contained information about the study, a questionnaire, and information about HbA1c. Forty two people filled in and returned the questionnaire.
The majority (88%) of patients felt that they would use the system if it was available, 74% said that they would be more likely to use the DBS system than making an appointment, 71% said that would be more likely to get their HbA1c tests done on time, 67% would prefer the dried blood spot test method of blood sampling to having blood taken at their GP.
62% of respondents said that they would like to have their HbA1c result before they had their regular diabetes appointment, with 36% not having a preference on whether they received their HbA1c result before appointments.
When asked what other benefits a DBS approach might have responses included:
saving own time (51%), saving GP practice time (27%), more convenient (16%), more control/empowerment, reduced travel, and more insight (8%), better accessibility (5%) and easier blood sampling with less bruising (3%).
When asked what other challenges might arise from a DBS approach, 63% of people could not foresee any challenges from using a DBS service. Some patients raised concerns about getting other tests done (11%), reliability of postal service (6%), using the device correctly (6%) and not understanding test results (3%).
Having previously established that the DBS service for HbA1c monitoring was acceptable from a clinical perspective and for patients who regularly attend hospital diabetes clinic appointments, this study has added the views of diabetes patients managed by GP practices.
The study has helped researchers/clinicians understand patient issues for introducing a DBS based approach to HbA1c monitoring.
Further research will map out the current HbA1c test ‘pathway’ and look at the impact of how where/what changes Will seek to address some of the issues raised for example, exploring the use of DBS for other tests which people with diabetes routinely have.REC name
Wales REC 6
REC reference
18/WA/0271
Date of REC Opinion
3 Aug 2018
REC opinion
Favourable Opinion