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The undesirability of labelling someone Diabetic without measuring their glucose and the lack of concordance of HbA1c with dysglycaemia was pointed out very forcibly to the DH......................who ignored it! Dr Ian D Watson Clinical Director, Clinical Laboratories Consultant Biochemist & Toxicologist Dept Clinical Biochemistry University Hospital Aintree Lower Lane Liverpool L9 7AL Tel +44 151 529 3575 Fax +44 151 529 3310 ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Martin Holland Sent: 27 February 2010 09:29 To: [log in to unmask] Subject: Re: Health Screening Hi Richard, Thanks for that very useful algorithm. How is it that the DOH has managed to sidestep the World Health Organisation's recommendations on the diagnosis of diabetes which, if I remember correctly, only uses fasting and 2 hour glucose? Perhaps the DOH does not know WHO they are? Can we trump DOH with WHO? Regards, Martin. ----- Original Message ----- From: Harris Richard <mailto:[log in to unmask]> To: [log in to unmask] Sent: Friday, February 26, 2010 2:30 PM Subject: Re: Health Screening Michael Is the GP referring to this section of the NHS health check programme for vascular diseases, which contains an algorithm for 'diagnosis of diabetes' following BMI >30? Several of our local GP surgeries have been following this and sending in HbA1c samples instead of fasting plasma glucoses, the chart states either is acceptable as a screen. It does then recommend an OGTT if Hba1c 42 - 48mmol/mol but it's still possible to measure Hba1c on 2 separate occasions and if both are >48mmol/mol (6.5%) in a non symptomatic patient with a BMI >30 then a diagnosis of diabetes can be made!! Are other members aware of this? How were the cut off values determined? What advice can you give when guidelines have been published by DOH? Richard Dr Richard Harris Senior Biochemist Kettering General Hospital -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Colley, Michael Sent: 24 February 2010 17:17 To: [log in to unmask] Subject: Re: Health Screening I've just been informed by a GP that they've been instructed to measure HbA1 in patients with high BMI as a screen for Diabetes. I was under the impression that HbA1 was so variable between individuals that it had not been shown to be useful for screening (except in the USA !!). Have I missed out on a change of opinion about its usefulness? Can anyone give me references? Michael Dr C M Colley Consultant Chemical Pathologist Great Western Hospital Swindon SN3 6BB Great Western Hospitals NHS Foundation Trust Great Western Hospital Marlborough Road Swindon SN3 6BB Tel 01793 60 40 20 http://www.gwh.nhs.uk Register to become a member of the Trust at https://members.gwh.nhs.uk This message and any files transmitted with it are confidential and intended solely for the individual(s) addressed. If you believe you have received this e-mail in error, disclosing, copying, distributing or retaining this message, or any part of it, is strictly prohibited; please notify the sender immediately and delete it from your system. Any views or opinions presented are solely those of the author and do not necessarily represent those of Great Western Hospitals NHS Foundation Trust. All messages sent by the Trust are checked for viruses but this does not, and cannot, guarantee that a virus has not been transmitted. The Trust accepts no liability for any damage caused by any virus transmitted with this e-mail. ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. 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Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/