[Out-patient determination of glycosylated haemoglobin in the monitoring and control of diabetes mellitus: systematic review of the literature].
OBJECTIVE
To compare out-patient determination of HbA(1c) with lab figures, by measuring metabolic control, quality of life and hypoglycaemia episodes, in adults with type-1 or -2 diabetes mellitus.


METHODS
Systematic review.


METHODS
MEDLINE (1966-August 2006), EMBASE (2000-August 2006), bases held by the Center for Reviews and Dissemination (DARE, INAHTA, NHS-EED), Cochrane Library (number 3, 2006), European Medication Agency, Food and Drug Administration and the European Network of Emerging Technologies. A manual search was made in Point of Care and in the register of trials, (ClinicalTrials.gov).


METHODS
Inclusion criteria were studies with type-1 or -2 diabetics who used portable out-patient devices and with comparison with lab references. Studies of minors, of any other kind of diabetes, of patients without a portable device and where the comparator did not include reference methods were excluded. Those that a priori met the criteria were recovered fully. A quality analysis was run according to the CASPe programme criteria and data were extracted with specific formulae. As meta-analysis was not possible, a qualitative synthesis was made.


RESULTS
Twenty publications were selected. The values of most devices correlated well (R(2)=0.85 and R(2)=0.059; P< .001). Some studies described increase in glycaemia control, with drop in HbA(1c) of 0.1%-1.5% (P< .01); therapy control was more intense (95% CI, 0.95-1.52) and visits to the doctor decreased.


CONCLUSIONS
Out-patient evaluations are rapid and comfortable, increasing patients' metabolic control. However, they possess certain limitations.
Ruiz-Aragón
Jesús
J
Agencia de Evaluación de Tecnología Sanitaria de Andalucía (AETSA), Sevilla, Spain. jesusm.ruiz.ext@juntadeandalucia.es
Villegas Portero
Román
R
Flores Moreno
Sandra
S
D000553:Ambulatory Care; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans
D006442:Glycated Hemoglobin