From Glendale, Arizona, USA:
I have a 6-year-old who was diagnosed four and a half years ago. She becomes hysterical when the A1c blood draw is mentioned, despite therapy sessions and relaxation techniques, etc. I feel that this is very traumatizing to the little ones and was discussing with our pediatric endocrine team the possibility of acquiring the Bayer DCA 2000+. Our support group will be discussing this at our next meeting. Have any pediatric endocrine teams been able to acquire the new Bayer DCA 2000+ without much hassle from insurance companies? Have any other support groups pursued getting this into their children's hospital using petitions, fundraising, etc?
The Bayer 2000+ instrument for A1c measurement is now a very reliable machine and relatively inexpensive. It is the most accurate of the instruments monitored by the American College of Pathologists proficiency testing program and has 95% confidence limits under normal working conditions of about + or - 8% and it has the considerable advantage that the test only takes 6 minutes so that the result can be available at the time of a clinic visit. Another advantage is that it is now considered a a 'waived' test by CLIA (Clinical Laboratory Improvement Act) this means that it can be set up in a doctor's office without having to comply with complex Federal regulations. Many hospital clinical laboratories also use this instrument if their A1c load is less that about 30 to 40 tests a day.
Some health insurance plans may insist that the test be done in a certain laboratory; but usually if the cost is competitive your doctor sometimes can get this waived on the grounds that an immediate result significantly improves the value of the test. The instrument is not suitable for home use, though I don't think you envisioned this; it does need some maintenance and controls need to be run with each batch of tests.
Having said all this, there is still a finger prick involved even though it involves taking only a tiny amount of blood into a capillary tube. Since you don't mention problems with home blood sugar monitoring or insulin injections I am assuming that what upset your daughter was a venipuncture and this, of course, is not required.
Additional comments from Dr. Deeb:I have used the DCA 2000 since its introduction to practice. The test is now waived by CLIA, the organization that regulates laboratories. That means it is easy to do and reliable. I have found it to be such. I, too, didn't like the trauma to the kids. I also like having the results the day of the test and clinic visit.
Insurance companies pay me to do the test.
[Editor's comment: The actual decision to invest in this machine, and to train the staff to use it, is usually up to the doctors or whoever does their lab testing. Perhaps your daughter's doctor has already decided in favor or against this investment or perhaps he/she is largely unaware of it. With Dr. O'Brien's commentary, you'll be more aware of some of the issues involved in using it, and might perhaps persuade your daughter's doctor to consider getting one!
I might add that my office has had a DCA 2000 for several years, and both my staff and my patients look forward to getting the glycohemoglobin result back in only a few minutes, during the office visit, and using the information to help plan any changes in the diabetes care plan for the next few months. WWQ]
Original posting 10 Sep 1998
Posted to A1c, Glycohemoglobin, HgbA1c
Last Updated: Tuesday April 06, 2010 15:09:00
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