Good Concordance between Home Kit A1C, Glucose Management Indicator, and Point-of-Care A1C: Potential Solutions to Glycemic Assessment during the SARS CoV-2 Pandemic

ABSTRACT

Due to the SARS CoV-2 pandemic, fewer in-person clinic visits have resulted in fewer point-of-care (POC) A1c measurements in youth with T1D. Therefore, there is an increased need to use alternate methods to assess A1c, including continuous glucose monitoring-derived Glucose Management Indicator (GMI) and home kit A1c. The University of Minnesota's home kit A1c (n=59), GMI (n=56), and POC A1c (n=16) were collected from youth with T1D (age 10.0 [5.3, 13.0] years, 42% female, and baseline A1c 12.4 ± 2.2%). Matched pairs were used for Bland Altman analyses and Lin's concordance correlation coefficient (pc) to evaluate the agreement between A1c measures. GMI data (up to 90 days) was captured using Dexcom Clarity. In relation to POC A1c, both home kit A1c (panel A) and GMI (panel B) showed a slight positive bias (mean difference 0.13 and 0.22%, respectively). Home kit A1c and GMI showed strong concordance to POC A1c (pc = 0.987 [0.963, 0.995] and 0.930 [0.835, 0.971], respectively). GMI (panel C) also showed a slight positive bias (mean difference 0.26%) and good concordance (pc = 0.803 [0.703, 0.871]) to home kit A1c. These data demonstrate that home kit A1c and GMI show strong concordance with POC A1c. Overall, home kit A1c and GMI may be potential solutions to glycemic assessment for telehealth visits, including during the SARS CoV-2 pandemic.