A1C analyzers

We currently use both the Abbott Afinion 2 and the Siemens DCA Vantage in our 20+ FM/IM physician offices. 

December of last year I performed a correlation study with the hospital lab analyzer, that we sometimes send A1c samples to, compared to the two POC analyzers and they were very comparable (approx. 0.97 r value).

Both are great analyzers but if I had to choose based off of ease of use it would be the Abbott Afinion 2.  Hardly any maintenance is required (no optic/filter checks like the Siemens DCA requires on a quarterly basis).  The only maintenance required for the Abbott is monthly cleaning.  Also, the QC for the Abbott does not need to be reconstituted as it does with the Siemens DCA.  As Pet mentioned, the Abbott is quicker by 3 minutes but as I observed while performing the correlation study, our MAs are not standing right by the analyzer counting down the minutes until they get results. 

The biggest hesitation we had with implementing the Abbott was only having 1 minute from time of sample collection to insert the cartridge into the analyzer (Siemens has a 5 minute window.)  All of our offices have 2 A1c analyzers so they do not have to worry about backups and thankfully do not seem to have an issue with getting the sample into the analyzer in time with either the Abbott or Siemens. 

One thing I am looking forward to about the Abbott Afinion 2 is that they are working on getting it approved for diabetes diagnosis while right now it is strictly to be used for monitoring of already diagnosed diabetic patients.

Hope this helps :)

Raychel

We use the Afinion system and it has worked well with no issues.

Thank you!

Here at my physician office , the afinion 2 analyzers were ordered waived testing so the MA can do it, no tubes fingerstick. 

I over see our Diabetes and Endocrinology clinic and they have 4 Siemen's DCA Vantages.

Waived testing performed by either the MA or RN seeing the patients in the clinic office.

It is a finger stick sample, 6 minute TAT on the instrument. Can be interfaced to the LIS through a middleware platform.

We have the same as Michelle.  We have DCA Vantages and they are interfaced through our QML to Sunquest and EPIC.

Adonica

We use the Afinion 2, no complaints.

Question on POC A1c patient result 'matching' the clinical lab result - I imagine this crosses analyzer lines but I'm not familiar with 'pipette tip' used by analyzers other than DCA Vantage (which is what we've used for 20 years).

When you get a complaint from an MD that something is 'wrong' with the analyzer because the patient result is far enough 'off' from the clinical lab result that you are worried there is a problem, you first do parallel  tests. Typically I start with fresh blood from the lab. I also request the testing site do a comparison fingerstick and venous draw from the patient the MD noticed discrepant results if that patient is returning to clinic 'soon'. If not, they pick another patient. For me, it's never the analyzer if I'm the testing personnel, so I suspect it's the fingerstick - getting blood properly into the pipette tip/wiping off tip properly.

Has anyone actually found an analyzer issue or, like me, you circle back around to training on technique?

Appreciate input! Thanks in advance, Peggy

We use both the Abbott Afinion 2 or Siemens DCA throughout our FM/IM clinics.  Since our DCAs are older analyzers, as an office experiences issues with their DCA we replace it with the Afinion. 2  I performed a correlation study between the Abbott, Siemens, and hospital lab using venous samples and both POC analyzers were very comparable (approx. 0.97 r value).

The Abbott Afinion 2 provides quicker test results and requires less maintenance than the Siemens DCA.

When we had MDs reporting that something was "wrong" they didn't realize that there is an allowable variation between venous and capillary samples tested.  This was a matter of educating them on the difference of sample type.

We also noticed variation in capillary fingerstick specimen collection among staff and we re-educated our MAs and nurses on proper technique. 

Performing the correlation study definitely gave providers the confidence in their patients' A1c results when proper technique and test procedures were being followed correctly.

Hope this helps!

Raychel

Hi Peggy,

I have performed parallel tests on the DCA Vantage analyzers that we have in our clinics against our Beckman Coulter analyzers in our core lab a couple of different times when the clinic physicians doubted their results and both times the results were very similar when I performed the testing. We just ended up going back around and re-training the clinic personnel on technique and collection. The DCA has always been a pretty reliable analyzer for us.

I completely agree, Peggy. We also use the DCA Vantage. It correlates pretty well with the lab method. When we have issues, they are most often preanalytical or postanalytical. We have had issues where the results were not put on the correct patient chart, so of course did not match what was expected. Handling the specimen correctly is important--wiping carefully so that the specimen is not drawn back out of the capillary. We do teach that if the results aren't what they expect, they should repeat the test. We have a rule that they first have to have a lab A1C, as that method can discover hemoglobin variants that can affect RBC lifespan and thus the A1C results. 

I have had a complaint from a department regarding the variation of results between the DCA Vantage and the main lab A1C result. To investigate I used fresh whole blood and ran samples on both instruments. The results correlated nicely. When the investigation was completed it was determined the staff in the clinics deviated from the collection technique of not wiping away the first couple drops. Re-training was performed on the entire staff and it is drilled into them the importance of sample collection during training and annual competency. We have not had a problem since but I still keep this as a talking point when visiting and observing the staff.