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GPs told to switch to HbA1c testing for diabetes diagnosis

Exclusive GPs are to be issued with new NHS guidelines this month requesting they use HbA1c testing for diagnosis of type 2 diabetes in a move Government research suggests will drive up the number of cases by a fifth.

Pulse has learned that the UK has decided to adopt World Health Organisation advice issued in March that GPs switch to use of HbA1c testing with a cut-off point of 6.5% for diagnosis of type 2 diabetes.


Patients with HbA1c levels between 6.0% and 6.4% will be considered as having impaired glucose regulation and also at high risk of diabetes.

Health departments in all four UK countries are working on new guidelines for GPs. But the move is controversial, with unpublished research finding there will be a 20% increase in diabetes prevalence under the diagnostic threshold, with increases of up to 30% in some ethnic groups.

Research has also suggested the technique could be inaccurate in older patients and levels may be naturally higher in black patients.

The UK guidelines will recommend GPs use blood tests to measure HbA1c levels in patients with suspected type 2 diabetes, and confirm a diagnosis in all patients with levels above 6.5% or above on two separate occasions.

The guidance, drafted by a UK-wide working body led by Dr Rowan Hillson, the Department of Health in England's national clinical director for diabetes, is due to be published this month and will be endorsed by the Primary Care Diabetes Society (PCDS), the Association of British Clinical Diabetologists and Diabetes UK.

HbA1c testing is not recommended for diagnosis of type 1 diabetes, and should not be used to diagnose type 2 diabetes in children, or patients with end-stage kidney disease, haemoglobinopathies or anaemia.

Dr Brian Karet, a GPSI in diabetes in Bradford and member of the PCDS committee who sat on the UK-wide guideline group, told Pulse: ‘It's going to detect more people at risk, especially in black and minority populations. There will be more people diagnosed [than with fasting plasma glucose] - it could be as much as 30%.

‘It will undoubtedly increase workload, particularly in practices in urban areas or those with large populations of ethnic minority patients.'

Professor Kamlesh Khunti, professor of primary care diabetes at the University of Leicester and a GP in the city, said overall the switch was likely to be ‘a good thing'.

‘Our research shows patients and professionals don't like oral glucose tolerance testing and I'm sure HbA1c testing will be preferable. It is more expensive but if you factor in patients' and GP time we more than make up for the extra cost. We need to pick more people up early to prevent complications in later life.'

NICE is due to decide this month whether it will review its 2008 guidance on type 2 diabetes.


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