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Hba1c for diagnosis

Dr Karen Adamson
What is HbA1c?

Glucose binds irreversibly to


haemoglobin in red blood cells, forming
HbA1c

The higher the glucose, the higher the


HbA1c

HbA1c reflects the prevailing blood


glucose over the preceding 2-3 months
Why Measure HbA1c?

Serial measures show how an individuals


glucose control, and thus risk of complications,
change in response to alterations in management
Measure 2-6 monthly
Set individual target levels
HbA1c as an Indicator
of Glycaemic Control
Available Measures of
Glycaemic Control
Fasting Plasma Glucose (FPG)*
Preferred test for diagnosis (mmol/l or mg/dL)
Snapshot of glycaemia

Oral Glucose Tolerance Test (OGTT)


Response to glucose challenge, can be used to diagnose disease

HbA1c (Glycated Haemoglobin)


Long-term measurement of glycaemic control (~3 months)

Postprandial Glucose (PPG)


Glucose level after eating (mmol/l or mg/dL)**

Random Blood Glucose (RBG)


Measures blood sugar at any point in time, normal levels not defined

Continuous Glucose Monitoring (CGM)


Assesses how blood glucose levels react to insulin, exercise and meals
*measured after at least 8 hours of fasting; **measured 1- 2 hours after eating
Not suitable for HbA1C
1) Rapid onset of diabetes
a) Suspected T1DM see symptomatic patient flowchart
b) Drug-induced: steroids, anti-psychotics, immunosuppressants a
fasting glucose may not be sufficient. Seek advice from diabetes team.
c) Pancreatic disease. Seek advice from diabetes team.
2) Pregnancy HbA1C reduced in pregnancy. Gestational diabetes should be
diagnosed by OGTT. N.B. OGTT diagnostic criteria are lower than for the
general population.
3) Conditions affecting Hb turnover / HbA1C assay
a) Haemoglobinopathy
b) Haemolytic anaemia
c) Severe blood loss, Blood transfusion
d) Splenomegaly / Splenectomy
e) Renal dialysis +/- erythropoitein
f) Anti-retrovirals, ribavarin, dapsone
Diagnosis of diabetes mellitus in symptomatic patie

Thirst, polyuria
Symptoma Unexpected weight loss
tic patient Recurrent infection
Blurring of vision
Discoloured/ulcerated feet

+
random glucose 11.1 mmol/L
or
fasting glucose 7.0 mmol/L

= DIABETES
Mild symptoms Severe symptoms
?ketotic vomiting / dehydration

URGENT
Full youn OR ketonuria
HOSPITAL
assessment g age (or ketonaemia*)
ADMISSION
& initiate
managemen
t of Type 2
Diabetes URGENT
discussion with *ketones can be
diabetes team measured on some
(may need insulin POC glucometers
therapy)
Diagnosis of diabetes mellitus in asymptomatic patients

(repeat on not diabetic


separate 6.0 mmol/L
random day)
glucose
11.1 mmol/L repeat high
6.1risk
6.9 Consider
fastin
fasting mmol/L HbA1C
INITIA 7.0 mmol/L glucose
g
L glucos diabetes
lab e
7.0
glucos
(random mmol/L
OR
random
e 7.8 11.0 mmol/L
fasting) glucose
fastin 6.1 6.9 mmol/L
g
glucos
e
suitable for HbA1C? *
YES NO
(repeat
blood test
HbA1C on a OGTT
separate
day)

not high not high


diabetes diabetes
diabeti risk diabeti risk
c c
41 42 47 48 fasting
6.0 6.1 7.0
mmol/mol mmol/mol mmol/mol glucose
6.9
mmol/L All glucose
AND OR OR
measurements used
2-hr for diagnosis must be
7.7 7.8 11.1
glucose laboratory samples
11.0
mmol/L