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Changing Values

This document discusses the changes in reporting HbA1c values and their implications for diabetes diagnosis and management. Before 2009, HbA1c results were presented as a percentage, but following changes to standardization, they are now reported in mmol/mol. Understanding the relationship between these values is important for diabetes control. The document highlights the WHO’s recommendation of 6.5% being equivalent to 48 mmol/mol for diagnosing diabetes. It also delves into the implications of these conversions for assessing patient control of diabetes.

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Changing Values

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  1. Changing Values

  2. When does 6.5 = 48?

  3. Is this a well controlled diabetic?

  4. Before 2009 • HbA1C results would have appeared as: Haemoglobin A1c 7.0% total Hb (3.6-6.8) The HbA1c is expressed as a percentage of the Total Haemoblobin relative to a calibrator aligned to the DCCT method

  5. After June 2009 • HbA1c results have appeared as: Haemoglobin A1c 7.0% total Hb (3.6-6.8) HbA1c (IFCC) 53 mmol/mol The second result has been obtained using the IFCC reference standard

  6. From June 2011 • HbA1c results will appear as: HbA1c (IFCC) 53 mmol/mol (<48)

  7. Relationship between old and new units • IFCC-HbA1c (mmol/mol) = [DCCT-HbA1c (%) – 2.5] x 10.929 International Federation of Clinical Chemistry Diabetes Control and Complications Trial

  8. Following agreement between the various professions a series of leaflets were produced outlining the changes.

  9. Standardisation of HbA1c Assays. HbA1c measured by ion-exchange chromatography as the glucose changes the charge on the haemoglobin molecule. Originally calculated as a percentage of the HBA peak. After the DCCT trial and the importance of meeting a set target was established a standardised approach was used to align methods to the DCCT method. Not a true standard, so a reference standard was produced and a method assigned by isotope dilution mass spectrometry. Enables to report values in molar terms.

  10. www.diabetes.org.uk/Guide-to-diabetes/Monitoring/Blood_glucose/Glycated_haemoglobin_HbA1c_and_fructosamine/www.diabetes.org.uk/Guide-to-diabetes/Monitoring/Blood_glucose/Glycated_haemoglobin_HbA1c_and_fructosamine/ • Calculator to convert from old to new units and links to leaflets one of which is for patients.

  11. Diagnosis of Diabetes • Based exclusively on fasting glucose and oral Glucose Tolerance Test. • March 2011 WHO issued a report with the following recommendation 6.5% = 48 mmol/L

  12. “Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus Abbreviated Report of a WHO Consultation March 2011” Available on the WHO Diabetes website

  13. Answer • When does 6.5 = 48? • When they refer to HbA1c measurements • An HbA1c of 6.5% = HbA1c of 48 mmol/mol.

  14. Is this a well controlled diabetic?

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