title: Automatic laboratory-based strategy to improve the diagnosis of type 2 diabetes in primary care.
abstract: BACKGROUND
  To study the pre-design and success of a strategy based on the addition of hemoglobin A1c (HbA1c) in the blood samples of certain primary care patients to detect new cases of type 2 diabetes.
  
  
  METHODS
  In a first step, we retrospectively calculated the number of HbA1c that would have been measured in one year if HbA1c would have been processed, according to the guidelines of the American Diabetes Association (ADA). Based on those results we decided to prospectively measure HbA1c in every primary care patient above 45 years, with no HbA1c in the previous 3 years, and glucose concentration between 5.6-6.9 mmol/L, during an 18 months period. We calculated the number of HbA1c that were automatically added by the LIS based on our strategy, we evaluated the medical record of such subjects to confirm whether type 2 diabetes was finally confirmed, and we calculated the cost of our intervention.
  
  
  RESULTS
  In a first stage, according to the guidelines, Hb1Ac should have been added to the blood samples of 13,085 patients, resulting in a cost of 14,973€. In the prospective study, the laboratory added Hb1Ac to 2092 patients, leading to an expense of 2393€. 314 patients had an HbA1c value ≥ 6.5% (48 mmol/mol). 82 were finally diagnosed as type 2 diabetes; 28 thanks to our strategy, with an individual cost of 85.4€; and 54 due to the request of HbA1c by the general practitioners (GPs), with a cost of 47.5€.
  
  
  CONCLUSIONS
  The automatic laboratory-based strategy detected patients with type 2 diabetes in primary care, at a cost of 85.4€ per new case.
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Salinas
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: López-Garrigós
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Flores
authors.affiliation: Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Leiva-Salinas
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Lugo
authors.affiliation: Department of Endocrinology, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Pomares
authors.affiliation: Primary Care Center of Mutxamel, Alicante-San Juan Department, San Juan de Alicante, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Asencio
authors.affiliation: Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ahumada
authors.affiliation: Department of Radiology, University of Missouri, Columbia, MO, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Leiva-Salinas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000379:methods* / Q000592:standards; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: HbA1c; cost analysis; costs; diagnosis; preanalytical phase; test request appropriateness; type 2 diabetes