Our experience of using HbA1c home-testing kits for paediatric type 1 diabetes patients to aid remote consultations during the COVID-19 pandemic

ABSTRACT

Introduction: The Reset, Restore & Recover initiative by the Royal College of Paediatricians (RCPCH), encouraged innovations which minimise exposure to and transmission of COVID-19. Objectives: We introduced a virtual surveillance initiative for Type 1 Diabetic (T1D) children in North West London. This consisted of integrating remote consultations with home HbA1c testing kits to optimise diabetic control. Methods: An initial telephone survey was conducted of 190 patients to ascertain preference for mode of remote testing.79/190 opted for drivethrough HbA1c testing and 106/190 for home testing kits. Home testing kits containing an instruction leaflet and sampling equipment were posted out to patients attending clinics virtually on 4 occasions over a period of 6months (December 2020-June 2021). The samples were sent to the hospital laboratory for testing via local GP practices with a result ready prior to the next Diabetes clinic appointment. During clinic appointments, parents were asked to provide qualitative feedback on the sampling process. Results: Out of 35 recruited patients,71.4% had a successfully reported HbA1c result in time for clinic appointment.28.6% of patients failed to receive a result in time for appointment. Within this cohort,30% of samples clotted,10% contained insufficient sample,10% were mis-labelled and 50% of samples were not received by the laboratory. Qualitative feedback highlighted challenges with the sampling process which prompted changes to the instruction leaflet and an alternate lancet device was provided in the packs. Conclusions: Our experience of using home testing kits was encouraging with a large proportion of patients successfully obtaining HbA1c results. This single method did not, however, work for all patients due to issues with obtaining enough blood and pain. For our large, diverse patient population, both home testing kits and drive-through point of care testing for HbA1c may need to be offered in order to continue with virtual consultations.