Pandemic-Associated Trends in Measurement of HbA1c in Children with Diabetes Mellitus and Validation of Dried Blood Spot as an Alternative Sample Matrix.

Garnett, Emily R; Recio, Brandy; Jung, Joanna; Tam, Estella; Devaraj, Sridevi

OBJECTIVE Routine monitoring of hemoglobin A1c (HbA1c) is the standard of care in diabetes mellitus (DM), but adhering to regular laboratory appointments may be challenging when access to care is limited, such as during the initial wave of the COVID-19 pandemic in the United States in 2020. MATERIALS We evaluated trends in patient encounters and laboratory testing for DM in a pediatric healthcare system from March to September 2019 and during the same period in 2020. RESULTS Evaluation of 17,367 patient encounters illustrated that the pandemic was associated with significantly fewer in-person office visits and point-of-care HbA1c tests for patients with DM in 2020 relative to 2019. A separate analysis of 7,193 HbA1c results measured by point-of-care testing in the general population found a significant increase in the number of measured HbA1c >14 % in May 2020 relative to 2019, but other measured HbA1c values did not differ. As a means to address lapses in the monitoring of HbA1c due to the pandemic, we evaluated the use of the dried blood spot (DBS) matrix for measurement of HbA1c by the Vitros 5600 chemistry analyzer. DBS HbA1c was well correlated to whole blood (r=0.9889) and exhibited intra- and inter-assay precision from 0.5-3.5%. CONCLUSION DBS measurement of HbA1c presents a viable alternative to routine in-person laboratory monitoring of DM.