HBA1c

Reference Ranges for HbA1c

• Normal: < 42 mmol/mol
• Pre-diabetes: 42-47 mmol/mol
• Diabetes diagnostic: ≥ 48 mmol/mol (confirmed on two separate occasions)
• Good diabetic control: target usually < 53 mmol/mol (individualised)

Primary Care Approach

Step 1: Interpreting the Result

• Check if HbA1c is used for diagnosis or monitoring
• Exclude anaemia or haemoglobinopathies which may affect results
• Always assess in clinical context: weight, symptoms, medications

Step 2: Pre-diabetes Management (42-47 mmol/mol)

• Offer lifestyle advice: diet, exercise, smoking cessation
• Consider metformin if high risk (e.g. obese, high-risk ethnicity)
• Repeat HbA1c in 3-6 months

Step 3: Diabetes Diagnosis (≥ 48 mmol/mol)

• Confirm diagnosis with second HbA1c test or fasting glucose
• Initiate diabetic care: foot check, retinal screening referral, BP and lipids assessment
• Discuss lifestyle changes and start medication if appropriate

Step 4: Monitoring in Known Diabetes

• Check HbA1c every 3-6 months
• Assess trends: rising levels may indicate non-compliance or need to escalate treatment
• Targets may vary based on age, frailty, comorbidities

When to Refer to Secondary Care

• HbA1c > 86 mmol/mol despite maximum oral therapy
• Recurrent hypoglycaemia or uncertainty about diagnosis
• Type 1 diabetes or suspicion thereof
• Need for insulin initiation or pump therapy
• Complications such as nephropathy or retinopathy

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