Recommendation of the International Expert Committee For the diagnosis of diabetes

Recommendation of the International Expert Committee For the diagnosis of diabetes

• The HbA1c assay is an accurate, precise measure of chronic glycaemic levels and correlates well with the risk of diabetes complications.

• The HbA1c assay has several advantages over laboratory measures of glucose.

Diabetes should be diagnosed when HbA1c is ≥6.5%. Diagnosis should be confirmed with a repeat HbA1c test. Confirmation is not required in symptomatic subjects with plasma glucose levels ≥11.1 mmol/l.

If HbA1c testing is not possible, previously recommended diagnostic methods (e.g. FPG or 2 hour OGTT, with confirmation) are acceptable.

• HbA1c testing is indicated in children in whom diabetes is suspected but the classic symptoms and a casual plasma glucose ≥11.1 mmol/l are not found.

 For the identification of those at high risk for diabetes:

The risk for diabetes based on levels of glycemia is a continuum; therefore, there is no lower glycemic threshold at which risk clearly begins.

The categorical clinical states pre-diabetes, IFG, and IGT fail to capture the continuum of risk and will be phased out of use as HbA1c measurements replace glucose measurements.

Those with HbA1c levels below the threshold for diabetes but ≥6.0% should receive demonstrably effective preventive interventions. 

Those with HbA1c below this range may still be at risk and, depending on the presence of other diabetes risk factors, may also benefit from prevention efforts.

 (Adapted from: The International Expert Committee. International Expert Committee Report on the role of the HbA1c assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327–34; 2009)