reference range (HbA1C)
You have 3 open access pages left.
UK healthcare workers and students can get FREE subscriptions... click here.

 
   

For diabetics:

  • HbA1c levels of between 6.5% and 7.5% are recommended by NICE (1)
    • a MeREC review (2) states that "..If appropriate and achievable in an individual, reducing blood glucose to HbA1c levels of around 7.5% would seem optimal based on current evidence. Lower levels may be appropriate for individuals with early disease..."

 

  • NICE note that (1):
    • when setting a target glycated haemoglobin (HbA1c):
      • involve the person in decisions about their individual HbA1c target level, which may be above that of 6.5% set for people with type 2 diabetes in general ยท encourage the person to maintain their individual target unless the resulting side effects (including hypoglycaemia) or their efforts to achieve this impair their quality of life
      • offer therapy (lifestyle and medication) to help achieve and maintain the HbA1c target level
      • inform a person with a higher HbA1c that any reduction in HbA1c towards the agreed target is advantageous to future health
      • avoid pursuing highly intensive management to levels of less than 6.5%
    • measure the individual's HbA1c levels at:
      • 2-6-monthly intervals (tailored to individual needs) until the blood glucose level is stable on unchanging therapy; use a measurement made at an interval of less than 3 months as a indicator of direction of change, rather than as a new steady state
      • 6-monthly intervals once the blood glucose level and blood glucose-lowering therapy are stable

Notes:

  • JBS2 suggest an optimal target for glycaemic control in diabetes is a fasting or pre-prandial glucose value of 4.0-6.0 mmol/l and a HbA1c < 6.5%. An audit standard for HbAlc of <7.5% is recommended
  • the HbA1c results will be reported exclusively as mmol/mol of haemoglobin without glucose attached, rather than a percentage as previously, from June 1st 2011
  • the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has initiated the change:
  • the equivalent of the current DCCT HbA1c targets of 6.5% and 7.5% are 48 mmol/mol and 59 mmol/mol in the new units, with the nondiabetic reference range of 4.0% to 6.0% being 20 mmol/mol to 42 mmol/mol
  • % 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8. 4.9
    mmol/mol 20 21 22 23 25 26 27 28 29 30
    % 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9
    mmol/mol 31 32 33 34 36 37 38 39 40 41
    % 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9
    mmol/mol 42 43 44 45 46 48 49 50 51 52
    % 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9
    mmol/mol 53 54 55 56 57 58 60 61 62 63
    % 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9
    mmol/mol 64 65 66 67 68 69 70 72 73 74
    % 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9
    mmol/mol 75 76 77 78 79 80 81 83 84 85
    % 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9
    mmol/mol 86 87 88 89 90 91 92 93 95 96
    % 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9
    mmol/mol 97 98 99 100 101 102 103 104 105 107
    % 12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9
    mmol/mol 108 109 110 111 112 113 114 115 116 117
    % 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9
    mmol/mol 119 120 121 122 123 124 125 126 127 128

Reference:

  1. NICE (May 2008).Type 2 diabetes The management of type 2 diabetes
  2. MeReC Bulletin June 2011; 21 (5)
  3. JBS2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91 (Supp 5).

Links: