Screening and Diagnosis of Type 2 Diabetes

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Check HbA1c

HbA1c < 41mmol/mol

HbA1c 42-47mmol/mol HbA1c > 48mmol/mol

T2D unlikely

'Impaired' or 'Pre-dabetes' Diagnostic of T2D

No further screening unless risk factor profile changes

Rescreen HbA1c annually
Do not measure blood glucose
Screening for or suspected type 2 diabetes (T2D)

This guideline is not suitable for people aged 25 years and under or 75 years and over

The guideline does not apply to ongoing MONITORING of people with an established diagnosis of diabetes

When NOT to use HbA1c to diagnose Type 2 diabetes

In the following situations diagnose diabetes by fasting glucose ≥7.0 mmol/L twice, or once with symptoms

  1. Rapid onset of diabetes :
    1. Suspected type 1 diabetes –rapid onset of symptoms, weight loss, ketosis
    2. Children – because most will have type 1 diabetes
      Both conditions require same day specialist diabetes team contact
    3. Steroids , antipsychotic & immunosuppressant drugs
    4. After pancreatitis or pancreatic surgery
       
  2. Pregnancy : The diagnosis of gestational diabetes should be made by using glucose measurements in line with SIGN guidance

Fasting glucose - 5.1 mmol/L or above
2 hr glucose in GTT - 8.5 mmol/L or above

  1. Conditions with reduced red survival:
    1. Haemoglobinopathy eg sickle trait, sickle disease or thalassaemia
    2. Haemolytic anaemia
    3. Severe blood loss
    4. Splenomegaly
    5. Antiretroviral drugs
  2. Renal dialysis patients
  3. Iron and B12 deficiency and their treatment
Glossary
Abbreviation Meaning
HbA1c Haemoglobin A1c
T2D Type 2 diabetes
GTT Glucose tolerance test
Editorial Information

Last reviewed: 30 September 2017

Next review: 30 September 2018

Version: 5

Approved By: high-tam@nhs.net

Reviewer Name(s): Prof MacRury

Document Id: TAM163