Point-of-need hemoglobin A1c for evidence-based diabetes care in rural small-world networks: Khumuang community hospital, Buriram, Thailand

Gerald J Kost, Anan Kanoksilp, Daniel M. Mecozzi, Rebecca Sonu, Corbin Curtis, Jimmy N. Yu

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives: The objectives of the study were (a) to perform point-of-care (POC) hemoglobin A1c (HbA1c) testing at primary care units (PCUs) in rural villages, (b) to devise strategies for improved diabetes control, (c) to improve efficiency managing high-volume diabetic patients, and (d) to implement a small-world network (SWN) of PCUs, a community hospital, and a regional hospital. Methods: Hemoglobin A1c instruments were rotated through 11 PCUs on diabetes clinic days in the Khumuang Community Hospital SWN, Buriram Province, Isaan, Thailand, then results characterized statistically for demographic differences. Quality control checked instrument consistency and operator competency. Results: Point-of-care HbA1c brought evidence-based primary care to villages for the first time. Only 17% had HbA1c of less than 6.5%. Nonnormal distributions were right skewed. Mean (SD), median (range), and third quartile HbA1c levels (%) were 8.3 (2.1), 7.8 (4-17.5), and 9.3, respectively, for all patients (N = 1188, aged 18-92 years); 8.4 (2.3), 7.8 (4.9-17.5), and 9.5 for 313 males; and 8.2 (2.0), 7.8 (4.1-16.1), and 9.2 for 875 females. Median male/female HbA1c did not differ significantly. Weighted-average top quartile HbA1c ranks at PCUs facilitated efficient treatment of patients with poorly controlled diabetes. Conclusions: Rapid on-site HbA1c testing of up to 150 diabetic PCU patients per day, quickly and efficiently identified those who were poorly controlled. Unexpectedly, elevated HbA1c changed primary care strategy, pulling together a rotating team of physicians, nurses, and a pharmacist who adjust therapy and accelerate checks for albuminuria to prevent advancing disease, dialysis, and adverse outcomes. This SWN motivates public health leadership to invest in POC HbA1c monitoring and enables diagnostic screening.

Original languageEnglish (US)
Pages (from-to)28-33
Number of pages6
JournalPoint of Care
Issue number1
StatePublished - Mar 2011


  • community hospital (CH)
  • estimated average glucose (eAG)
  • Isaan
  • point-of-care (POC) testing
  • primary care unit (PCU)
  • quartile weighted average
  • regional hospital (RH)
  • sugarcane
  • Thailand
  • therapeutic turnaround time

ASJC Scopus subject areas

  • Nursing(all)


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