P-BC-2 - Assessing the Impact of Routine Hemoglobin A1c Testing in Blood Donation Centers for Diabetes Surveillance

More than 1 in 10 adults worldwide have diabetes, with nearly 50% undiagnosed. Hemoglobin A1c (HbA1c) testing is widely available to diagnose and monitor disease progression and blood donation centers can play a pivotal role in public health surveillance. This study evaluates the impact of incorporating HbA1c screening for all donors and notifying individuals of potentially new diagnoses.

Study

Design/Methods:

HbA1c testing was incorporated into the standard blood donor testing procedure at an academic blood center. Basic demographic data, donation history, and past/current history of pre-diabetes/diabetes were collected. HbA1c levels were classified as normal ( < 5.7%), pre-diabetes (5.7-6.5%), or diabetes ( >6.5%). Donors with abnormally elevated HbA1c without a diabetes/pre-diabetes history were informed of the results. Statistical significances were determined by applying Chi square or Wilcoxon rank sum tests as appropriate.

Results/Findings:

We evaluated data from 26583 whole blood and 5423 platelet donations over 8 months. Overall, 14% of all donations had abnormal HbA1c levels. Strikingly, the majority (56%) of abnormal HbA1c results were from donors without a history of diabetes/pre-diabetes, with pre-diabetes representing 92% of these first-time diagnoses. For whole blood donors, we observed significant differences in first-time diagnosis between genders (F: 54% vs M: 61%, p< 0.01) and age groups (range 52-80%, p< 0.01), but not between counties or ethnicities; for platelet donors, significant differences were observed only between ethnicities (range: 50-88%, p< 0.01) and age groups (range: 51-81%, p< 0.01). Next, for whole blood donors without a history of diabetes/pre-diabetes, we found significant differences in the proportion of diabetes between ethnicities only (Range: 0-30%, p< 0.01); for platelet donors, significant differences were found between genders (F: 15% vs M: 6%, p< 0.05), ethnicities (range: 0-44%, p< 0.01), and age groups (range: 0-33%, p< 0.01). Finally, there was no significant difference in the average number of donations per donor after implementation of HbA1c when compared to a matched time-period before implementation.  However, there was a significant reduction in the average time between whole-blood donations (84 vs. 81 days, p< 0.01).

Conclusions:

Incorporating HbA1c testing in blood donation centers is an effective strategy for early diabetes detection and promoting community health, as underscored by the substantial proportion of donors unaware of their elevated HbA1c levels. Additionally, observed differences in new diagnoses and the proportion of pre-diabetes versus diabetes across demographic groups highlights opportunities for targeted outreach. Finally, although routine HbA1c testing showed minimal overall impact on donor behavior, more longitudinal data will help fully elucidate the long-term impacts on both donor behavior and HbA1c-related health outcomes.