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ACB-CLIN-CHEM-GEN  July 2009

ACB-CLIN-CHEM-GEN July 2009

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Subject:

HbA1c dual reporting

From:

Gary Mascall <[log in to unmask]>

Reply-To:

Gary Mascall <[log in to unmask]>

Date:

Fri, 3 Jul 2009 16:44:03 +0100

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I would like to know if, and how, others are carrying out dual reporting of 
HbA1c, which should have been started June this year.

Our instrument supplier TOSOH, have made a software adjustment as follows.
HbA1c calibrated against DCCT standard
HbA1c (IFCC) calculated using agreed equation.
HbA1c (DCCT) back calculated from HbA1c (IFCC) and only this is reported 
out of analyser to their data station, so only HbA1c (DCCT) sent to LIS.

So, we could use the same equation in the LIS to re-calculate HbA1c (IFCC), 
(how far removed is that from the original calibration???) as a calculated 
result, and then report both DCCT and IFCC values.

However, at some time in the future, possibly in December, they will start 
calibrating against an IFCC standard, and then calculating the DCCT value, 
with the option, we are told to output either DCCT or IFCC, but not both 
results.

My concern is that at some time in the future, we will need to bite the bullet 
and report the HbA1c (IFCC) value from the analyser, and immediatley we 
start that, then on the LIS we will lose the historical data from the reports, as 
there would be 3 test codes for HbA1c in the LIS, so continuity of care and 
looking back at results will be a nightmare, as we will have
HbA1c (DCCT) - measured
HbA1c (IFCC) - calculated
HbA1c (IFCC) - measured

I would be interested to hear how others are approaching this, and indeed to 
know what discussion has been undertaken with pharmaceutical companies, as 
today there were 2 reps touting their products for Diabetes, both of which 
show 1% reduction in HbA1c (DCCT) levels, but nowhere was there any 
mention of the comparible HbA1c (IFCC) values, nor were they aware of what 
the new values should be.

Clearly we are at the early stages of this process, but I really do not want to 
wait to see what the suppliers come up with at the end of December, which is 
when they argue they are required to make this switch, and therefore reduce 
the time doctors and patients have come to understand the new treatment 
numbers.

Regards,
Gary

Gary Mascall
Consultant in Clinical Biochemistry
Worcestershire Acute Hospitals HNS Trust.

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