Diabetes: The Advantages and Disadvantages of Point of Care Testing

NB: We do not resell your papers. Upon ordering, we do an original paper exclusively for you.

NB: All your data is kept safe from the public.

Table of Contents

Introduction
Point of Care Testing
Advantages of Point of Care Testing
Disadvantages of point of care testing
Additional tests required for long term control of the disease
Plasma/blood tests
Urine glucose test and ketones test
The Glycated protein tests for diabetic
Conclusion
Reference List

Introduction

The following is an evaluation of the advantages and disadvantages of point of care testing with reference to diabetes. The additional tests required for long term control of the disease are also discussed. It is important to first define the meaning of diabetes and point of care testing before determining the advantages and limitations of point of care testing. Diabetes is a relatively familiar condition in the world today. It is a collection of metabolic illnesses whereby the blood sugar is higher than normal.

High blood sugar has the effect of producing the classical symptoms making one to urinate frequently. In addition, one feels thirsty and hungry most of the times. Diabetes occurs in two types, 1 and 2. When the body fails to produce insulin, it results to type 1 diabetes. According to This type of diabetes therefore calls for an insulin injection (American Medical Association & College of American Pathlogists.2007, 71). Type 2 results from the failure of insulin to function well in the body and therefore causing insulin resistance complications. An insulin resistance complication arises once the cells fail to utilize the insulin well.

Other modes of mellitus diabetes are gestational diabetes, which is associated with pregnant women, congenial diabetes, and steroid diabetes among others. All the above types of mellitus diabetes can be easily dealt with through improving the insulin functionality. However, type2 diabetes may be managed through prescriptions. Mellitus diabetes has long-term effects, which includes; damaging the retinal, cardiovascular illnesses, hypoglycemia among other effects. Diabetes Mellitus is very costly to manage and therefore, frequent treatment is essential since it ensures that the blood pressure is controlled. Frequent treatment is also ideal as it helps to check the body weight (Ozcan, 2003, 86).

Approximately, more than 120 million of the world’s population have diabetes.For instance, Type 2 diabetes is the most prevalence in the United States affecting more than 85% of the adults (Lewandrowski, 2001, 58).

Point of Care Testing

Point of care testing commonly referred to as POCT is an analytical testing whereby, the patient’s samples are tested outside the laboratory in the vicinity of the patients medical staff.The medical staff are usually untrained and the devices used may be situated in portable carts. Point of care testing thus brings the laboratory tests to the patients instead of sending the patients to the laboratories. Point of care testing has been enhanced through the development of transportable analyzers that ensures rapid test outcomes (Estridge et al., 2000, 17). Point of care testing was because of development of the blood glucose monitors for home usage by the diabetics.

Point of care testing is implemented to reduce the overall time involved for analytical tests and thereby enhancing the patients’ treatment.However, the reduction of overall time involved in analytical tests does not enhance the patient’s conditions most of the times. The technological innovation has played an important role of instrument design and this has led to the development of smaller and sophisticated instruments that are easy to use for the analytical tests (Williams, 2002, 89). The following are the advantages and disadvantages of Point of Care Testing;

Advantages of Point of Care Testing

Point of Care testing is associated with the reduction of turn-around time i.e. the laboratory tests are obtained rapidly implying that there are minimal or no quality controls that are required during screening. For instance, the POL which is a point of care testing program allows blood glucose tests,haemoglobin tests and other tests to be performed rapidly by the medical assistants before the diabetes patients sees the medical doctors.

This implies that the medical results are readily available for the doctors in order to make decisions regarding the patient’s follow-ups or further treatment. This is thus an efficient mode rather than sending the patients to a hospital laboratory to get tested wait for results and then come back at a later period in order to get to know about their conditions (American Diabetes Associatioin, 1991, 23-24). The laboratory time for care testing is 14 days, which is far much higher than the turn-around.

The reduced turn around time is ideal as it motivates the medical staff. The point of care testing also allows the patients to share information with the staff. Therefore, patients are able to discuss about their diabetes conditions and receive immediate answers. This helps to save time and the anxiety associated with waiting for the results (Price et.al, 2004, 142).

Point of care testing helps to improve the patient’s outcome due to the reason that the analytical tests are conducted while being close to the patients. By conducting the analytical tests in close proximity, the outcomes are obtained immediately and therefore, the staff can immediately detect areas that require to be improved so as to enhance the patient’s conditions. The reduced turn around times, helps to improve the outcome of the patients by increasing efficiency i.e. the delays and follow-ups that are costly with regards to the patient’s outcomes are avoided. The patients are able to discuss their diabetes condition face-to-face with the staff as opposed to telephone conversations and this promotes joint decision-making.

There are complex behavioral changes that are required for the diabetes’ patients and therefore, point of care testing plays an important role of helping the patients monitor their blood glucose. This blood glucose’ self monitoring process is essential for diabetes patients especially those that are suffering from type 2. POCT ensures that the meals compositons, mealtimes and physical activities are controlled. It also helps to detect and avert the hypoglycemia and also to assess and maintain metabolic controls especially during the acute illnesses (Ford, 2006, 65).

The home testing application of point of care testing has played an important role with regards to self-monitoring by the patients. The diabetes patients for instance have found the glucose meters to be very important as far as their self monitoring is concerned. Capillary testing has also enhanced the patients’ ability to maintain their glycemic controls as opposed to obsolete methods like urine glucose tests.

Capillary testing plays an important role of diagnosing gestational diabetes. Point of care testing ensures that parental care is conducted on routine basis. Gestational diabetes is usually screened for pregnant women in order to test the acceptable level of venous plasma. The reflectance meter is used to measure the venous samples and is an effective tool as it ensures that accuracy is attained (Garcia, 1999, 69).

Point of care testing helps to reduce the prevalence of chronic complications in diabetes. Chronic complications refers to the main outcomes of diabetes mellitus particularly type 2 and these complications has the effect of reducing the patients’ life quality, incurring huge financial burdens and also increasing the death rates among the patients. The Chlamydia screening plays an important role of reducing the occurrence of complications especially in women who suffers from gestational diabetes (Bernoville, 1999, 76).

Point of care testing involves the cross-trained medical staffs who maximize the productivity. In point of care testing, the health care expert’s works as a team. Teamwork is important as it enhances job satisfaction and this in turn helps to increase the patient’s welfare. Teamwork also contributes to improved health care quality and more productivity. Highly performance teams also play an important role as they offer huge support to medical staff that has low experience (Bishop, & Fody, 1978, 24).

Teamwork also helps to reduce the stress levels due to the fact that the members monitor their performance and therefore giving feedback among themselves. This thus helps to reduce the error rates. In point of care testing, the cross training of medical staffs enhances teamwork (Northwestern University, 2005, 42).

Point of care testing is associated with better laboratory –nursing units which facilitate effective communication. The fact that results are immediately established helps to improve communication between the health care givers and the patients. Communication is essential because it is through the communication that the patients are educated on how they can manage their conditions. Communication also accelerates the decisions that are made concerning the patients’ health condition and therefore, the patients become the center of attraction whereby, the decisions that are made are directed towards improving the health condition of the patient (Guthrie, & Guthrie, 2008, 46).

Point of care testing helps to reduce the workload required for the central laboratories. The point of care testing has developed a strategy that enables better management of the program. For instance, an interdisciplinary point of care testing which comprises of the nurses and physicians has been set so as to determine the analytical tests menu, establish procedures and policies, and select the technologies and also to ensure that there is compliance with regards to training.

Point of care testing helps to reduce the healthcare care resources that are needed for each diabetic patient. In many occasions, the cost concerning diagnostic tests does not appear. This makes the point of care testing to be highly preferred among the diabetic patients (Jacobs, 2008, 45).

Point of care testing has adopted the use of information technology in the recent years so as to enhance its effectiveness. The increased use of computers and microchips has made it possible for the patients to monitor themselves. This has also made it possible for the lesser trained staff to perform the analytical analysis. The information technology has thus made the point of care testing to be more flexible as compared with the laboratory testing (Lee, 2009, 201).

Point of care testing is often cheaper than laboratory testing as a result of reduction in the turnaround time. Point of care testing enables the diabetes patients to receive treatment quickly as well as shortening the patient’s wait. This means that the transport expenses are reduced making it to be cheaper than laboratory testing. The methods that are used in point of care testing are usually simple implying that any person who has some basic health care training can be able to perform the analytical tests.

The sampling types that are required in point of care testing are usually not invasive as opposed to the ones that are required in central laboratory tests and this thus makes POCT to be more acceptable by the patients.Aslo, there are no logistics that are required in transporting specimen to central laboratory and therefore errors that are associated with assigning incorrect patient details are greatly reduced (Brubaker, & Simpson, 1995, 53).

Disadvantages of point of care testing

The following are the advantages of point of care testing with reference to diabetes. The equipment for point of care testing is usually expensive as opposed to the equipment used in central laboratory testing. There are complicated technologies that are used in point of care testing and so, much expertise and time have been invested by the manufacturers making the equipment to be costly.

The reagents on the other hand have limited life implying that they require to be replaced if the analytical tests are not conducted more often. A single test is thus very expensive in point of care testing as compared to the central laboratory tests. With the sophistication of technology, the point of care testing has been less sensitive as compared to the laboratory testing. Usually, the training of point of care testing kit users is often neglected implying that it is easy for systematic errors to creep in.

Errors are therefore not easily noticed and there is a possibility of ignoring random errors. Also, the point of care testing poses uncertainty in that, the systems used for recording the results may fail to capture all the patients’ records as opposed to the central laboratory. The nurse may thus record patient’s information in patient’s notes and fails to do so in the central record (Slee, & Joachim, 2001, 56-59).

Point of care testing demands regular audits so as to be certain that the patients are provided with the necessary information and this is also costly. On the other hand, the costs of analytical tests for diabetic patients in point of care testing are higher as compared to that of laboratory. Point of care testing direct charges for diabetic patients is higher as opposed to that of central laboratory. The central laboratory has the advantage in that, it can duplicate the tests.

The central laboratory also enjoys economies of scale as opposed to point of care testing and this makes the central laboratory to be deemed as cheaper. In point of care testing, such costs as machine costs, maintenance, storage e.t.c.requires to be considered and this makes point of care testing to be expensive compared to central laboratory testing. The glucose costs in point of care testing is usually costly i.e. about five times higher than that of the central lab implying that point of care testing program requires many resources than the central laboratory testing.

Also, the point of care devices is not accurate as compared to the instruments that are used in the main laboratory (British Medical Associatiion, 2005, 75). The glucose meters used in point of care testing for instance has 20% accuracy level as compared to laboratory instruments that have more than 94 % accuracy level. On the other hand, the reference ranges of point of care testing are usually different. Point of care testing devices usually depends on operators for performance.

This implies that the visual results are likely to change with regards to specimen loading differences. Therefore, slight variations can affect the point of care testing results.Aso, the point of care devices are usually limited in that, they cannot store huge amounts of data. They thus require periodic downloading which is a bit cumbersome. It is also very expensive to connect the point of care devices. This is due to the fact that various manufacturers have developed their user interfaces independently and uniquely. In other words, the points of care testing devices are not standard and they therefore provide varied information to the users (Gibbons et.al, 2009, 92).

Point of care testing is usually a complex method and poses various chances of committing an error i.e. in order to deliver quality, point of care testing, there are several multidisciplinary coordination’s that are required. Poor communication in point of care testing provides opportunities for error. The progress of point of care testing entails a clear understanding of the patient care and in most occasions, the staff fails to do so and this makes system to be less effective (Williams, et al., 24, 2003).

Additional tests required for long term control of the disease

Diabetes is usually a serious disease and it estimated that more than 20 % of adults particularly in developed nations have diabetes. The additional tests will play an important role of diagnosing and monitoring diabetes. The following are the additional tests that are required for long term control of the disease i.e. plasma tests, urine glucose and ketone bodies tests and glycated protein tests. The purpose of these additional tests is to screen people in order to know as to whether or not they have diabetes. Earlier detections are vital since they help people to be aware of their condition and seek for treatment in advance (Wilkinns & Williams, 2006, 68)

Plasma/blood tests

Plasma tests are aimed at measuring the glucose levels. The three Plasma glucose tests are fasting, oral tolerance and causal plasma which are explained in the following paragraphs. For Fasting plasma test, it usually takes 8 hours fasting period which helps in testing the level of glucose in the body (AMACAP, 2007). Fasting has the effect of stimulating the hormone glucagons’ release and this helps to raise the level of plasma glucose (Bishop et al., 2000, 52).

The level of glucose for the persons suffering from diabetes is always higher than the acceptable level. Oral tolerance test takes one hour intervals within which the blood glucose is tested. The diabetic patients are given a glucose solution which causes a rise in the glucose levels during the opening one hour. The glucose levels falls to normal level within a period of three hours for the reason that the body releases insulin which helps to normalize the level of glucose. Random tests also referred to as causal plasma test and can be administrated at any given time. These tests are performed even if the patient has not eaten (Feinglos, & Bethel, 2008, 29).

Urine glucose test and ketones test

These are self monitoring tests aimed at detecting the main hyperglycemic episodes with reference to patients who may be unwilling to undergo through the blood glucose screening. These tests are carried out two to three times a week. The target of these tests is to separate the urine from glucose (Olefsky, 2004, 30).

The Glycated protein tests for diabetic

These are those tests that are performed in order to enable one to determine the glucose content of his or her body. Glycated protein tests therefore indicate the levels of fructosamines or the plasma. It determines the average level of glucose in a patient within a period of three weeks (Nicholas, 2003, 64).

Conclusion

Point of care testing is among the most controversial issues relating to laboratory medicine. The controversy is a result of the testing cost, the staff competency and the relationship between POCT and the similar testing that are conducted elsewhere. The main objective of point of care testing is to produce the results more quickly as opposed to most of the equivalent tests that are performed in the central laboratory.There are various reasons as to why the reduction in turn around time is necessary with regards to clinical considerations. The technological innovation today has enhanced the reliability of point of care testing devices (AMACAP, 2007).

Point of care testing encompasses various medical staff e.g. nurses, physicians, therapists e.t.c. It is usually performed in the homes and examination rooms of physicians and emergency department. POCT approach is very crucial clinically and also convenient to both the patients and the care givers.However, the cost involved in point of care testing may be a bit higher as opposed to that of the laboratory and therefore it should be applied as and when necessary.

Point of care thus has such benefits as maximizing the productivity of staffs, reducing the workload for central labs among others (Bernoville, 1999). Point of care testing has some disadvantages such as higher analytical costs, lack of efficiency among the care givers, different reference ranges and poor data management. There is need to consider additional tests for the long term control of the disease. Some of the additional tests include the plasma tests, urine glucose and ketone bodies tests and glycated protein tests.

Reference List

American Diabetes Associatioin., 1991. Diabetes care. Illinois: Northwestern University.

American Medical Association & College of American Pathologists (AMACAP). 2007.

Archives of Pathology & laboratory medicine, Volume 131, Issue 7. New York: College of American Pathologists.

Bernoville, F. 1999. Diabetes Mellitus. New Delhi: B. Jain Publishers.

Bishop, M. L. & Fody, E. P., 1978. Diabetes mellitus: theory and Management. London: Urban & Schwarzenberg.

Bishop, M. L. et al., 2000. Clinical chemistry: principles, procedures. Philadelphia: Lippincott Williams & Wilkins.

British Medical Association. 2005. Diabetes mellitus. British medical journal, Volumes 7524-7531. New York: the University of California.

Brubaker, D. B. & Simpson, M. B., 1995. Dynamics of homeostasis and thrombosis. New Yok: American Association of Blood Banks.

Estridge, B. E. et al., 2000. Basic medical laboratory techniques. Stamford: Cengage Learning.

Feinglos, M. N. & Bethel, M. A., 2008.Type 2 diabetes mellitus: an evidence-based Approach to practical management. New York: Humana Press.

Ford, A.M., 2006. Focus on diabetes mellitus. New York: Nova Publishers.

Garcia, L., 1999. Practical guide to diagnostic parasitology. US: ASM Press.

Gibbons, M.C. et al., 2009. Handbook of Digital Homecare. Berlin: Springer.

Guthrie, D.W. & Guthrie, R.A., 2008. Management of diabetes mellitus: a guide to the Pattern approach. Berlin: Springer Publishing Company.

Jacobs, D. S., 2008. Laboratory test handbook. Hudson: Lexi-Comp.

Lee, M., 2009. Basic Skills in Interpreting Laboratory Data. Bethesda: ASHP.

Lewandrowski, K., 2001. Point-of-care testing. London: W.B. Saunders Co.

Nicholas, J. H., 2003. Point-of-care testing: performance improvement and evidence-Based outcomes. New York: Marcel Dekker.

Northwestern University., 2005. Archives of pathology & laboratory medicine. Illinois: Northwestern University.

Olefsky, J. M., 2004. Diabetes mellitus: a fundamental and clinical text. Philadelphia: Lippincott Williams & Wilkins.

Ozcan, S., 2003. Diabetes mellitus: methods and protocols. New York: Humana Press.

Price, C. P. et al., 2004. Point-of-care testing. New Yok: American Assoc for Clinical Chemistry.

Slee, V. S & Joachim, H., 2001. Slee’s Health care terms. Sudbury: Jones & Bartlett Learning.

Wilkinns, G. & Williams, L., 2006. Diabetes mellitus: a guide to patient care. Philadelphia: Lippincott Williams & Wilkins.

Williams, D. R., 2002.The evidence base for diabetes care. Hoboken: John Wiley and Sons.

Williams, R. H. et al., 2003. Clinical Diagnostic Technology: The Total Testing Process. New Yok: American Assoc for Clinical Chemistry.

Click Here To Order Now!