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Hi Angela We also seem to have moved very rapidly to the apparent abandonment of 'pre-diabetes' (usually regarded as being IFG and/or IGT) according to p4 of the full guidance: • • The referral [to NICE from the DoH]……originally set out to address the prevention of ‘pre-diabetes’ among adults. • However, in January 2011 the WHO recommended that HbA1c could be used as an alternative to standard glucose measures to diagnose type 2 diabetes ….but there is no fixed point to indicate when someone has ‘pre-diabetes’. • The title of this guidance has been changed since it went out for consultation to reflect this move away from recognising ‘pre-diabetes’ as a separate condition. Which is an interesting interpretation of the actual WHO wording: 'An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes. A value less than 6.5% does not exclude diabetes diagnosed using glucose tests. The expert group concluded that there is currently insufficient evidence to make any formal recommendation on the interpretation of HbA1c levels below 6.5%.' Eric Professor E S Kilpatrick Department of Clinical Biochemistry Hull Royal Infirmary Anlaby Road Hull HU3 2JZ Tel 01482-607708 Fax 01482-607752 Date: Tue, 10 May 2011 15:13:56 +0100 From: [log in to unmask] Subject: HbA1c in diagnosis of DM (2) To: [log in to unmask] From the latest NICE guideline ‘Preventing Type 2 Diabetes’: “Type 2 diabetes is diagnosed in adults who are not pregnant by a glycated haemoglobin (HbA1c) level of 6.5% (48 mmol/mol) or above. A type 2 diabetes diagnosis can also be made by: random venous plasma glucose concentration the same or greater than 11.1 mmol/l; or fasting venous plasma glucose concentration the same or greater than 7.0 mmol/l; or 2-hour venous plasma glucose concentration the same or greater than 11.1 mmol/l 2 hours after 75 g anhydrous glucose in an oral glucose tolerance test (OGTT).” Does anyone else think that we went very quickly from HbA1c can be used for the diagnosis of DM to it being the first line test? Regards, Angela Angela Kremmyda Senior Biochemist Dept of Clinical Biochemistry Royal Shrewsbury Hospital Mytton Oak Road Shrewsbury SY3 8XQ Tel: 01743 261158 Fax: 01743 261159 This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in aliance on its contents: to do so is strictly prohibited and may be unlawful. ------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. 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/