HbA1c – The new numbers are starting now!

Published: 03 June 2009

Mags Bannister, Chair of the Diabetes Nursing Forum, has the latest on the introduction of the new HbA1c reporting method.

From June, all laboratory HbA1c results in the UK will be calculated using a new IFCC reference method which is being introduced worldwide to improve consistency in HbA1c reporting. This new method means that the results will no longer be presented as percentages, but instead as mmol/mol results. Thus the non-diabetic range for IFCC- HbA1c is 20-42mmol/mol.

What does that mean in practice?

From 1 June till 31 March 2011, HbA1c results will be dual reported on all the laboratory systems with reports stating IFCC- HbA1c as mmol/mol and DCCT- HbA1c as a percentage result (%). However, from 1 April 2011 only the IFCC- HbA1c mmol/mol result will be reported.

Over the next two years we have to educate ourselves and our patients about what the new numbers mean and what constitutes good, acceptable and poor control.

To help us do this, Diabetes UK and NHS Diabetes, in conjunction with the Association for Clinical Biochemists, have produced education leaflets for both health care professionals and patients to explain the changes. Order these free leaflets from Prontaprint in Leicester at: diabetes@leicester.prontaprint.com or telephone 0116 275 3333, quoting:

"DIABETES 100" for HbA1c standardisation for clinical health care professionals
"DIABETES 102" for A change in reporting your HbA1c results. Information for people with diabetes.

The aim is that every patient will receive a copy of the leaflet with their current IFCC- HbA1c result. My understanding is that they will send out up to 100 patient leaflets at a time.

Many patients still struggle to understand exactly what their HbA1c results means and how it differs from their blood glucose level. This is a great opportunity to provide them with clear information about their HbA1c and, we hope, help them understand the difference between their blood glucose readings and HbA1c.

The challenge

As both results will be available, there is likely to be a temptation to continue discussing the old results and a potential to ignore the new readings. Following discussions with patients groups, it is important that we avoid this temptation and use the period of dual reporting to make sure everyone becomes familiar with the new numbers.

Realistically many patients may only have two or three HbA1c readings performed during the period of dual reporting.

Patients have stressed that during this period they want to understand what the new numbers mean, not how the two sets of numbers compare. Table 1 shows the relationship between the two set of results.

Targets

The new target for HbA1c readings for patients with type 2 diabetes in line with NICE guidance will be a 48mmols/mol. A reading of 59 mmol /mol will be the trigger to consider triple therapy.

DCA machines

For those areas of clinical practice that use DCA machines to measure patients' HbA1c levels, there will be a slight delay in the switch-over. DCA vantage machines will be upgraded by a software upgrade that is currently being developed and will be installed free by Siemens.

The DCA 2000 analysers, however, will need to be replaced, but Siemens is currently offering a significant discount (about 50 per cent) in the cost of replacing the analysers. If you current use a DCA 2000 analyser, I suggest you contact your Siemens representative to discuss your replacement options.

In the meantime Siemens will be distributing conversion charts to be used until the new software and machines are in place.

The introduction of the new numbers will no doubt cause some problems for us all in the first few months, but by using the leaflets available to us and discussing results with patients we hope to adapt well to the new results and improve patient understanding of HbA1c results and how they reflect the quality of their glycaemic control.