1. Changing Values

2. When does 6.5 = 48?

3. Is this a well controlled diabetic? DateHbA1c mmol/mol 23/04/201145 01/11/201048 12/01/201055 15/11/200965 01/09/200970 03/07/200986 03/05/200575

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_ha emoglobin_HbA1c_and_fructosamine/www.diabetes.org.uk/Guide-to- diabetes/Monitoring/Blood_glucose/Glycated_ha emoglobin_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? DateHbA1c mmol/mol HbA1C % 23/04/201145 6.6 01/11/201048 6.9 12/01/201055 7.5 15/11/200965 8.4 01/09/200970 8.9 03/07/200986 10.4 03/05/200575 9.4