This protocol can be found on the OneLauncher -> Results -> HbA1c OR manually launched from the F12 menu by looking for the protocol HP064 HbA1c Interpretation
It is especially helpful if you are in pathology workflow and are reviewing an HbA1c result for a patient, and as part of a managed process within a practice could allow the delegation of these results to another member of staff.
The protocol performs the following actions:
- Checks that an HbA1c is appropriate for diagnosis
- Gives you an interpretation of the HbA1c result
Checking that an HbA1c is appropriate for diagnosis
The first thing that this protocol does is to check that it is ok to use an HbA1c to assess the patient for diabetes or pre-diabetes.
It assesses for:
- eGFR<30
- Systemic steroids in the last 3 months
- Aged under 30
- Iron deficiency anaemia
- last Hb <110
- Haemolytic anaemias
- Alcoholism
- Liver disease
- Pernicious anaemia
- Pregnancy
- Untreated hyperlipidaemia
If your patient is ok to use HbA1c to screen for a diagnosis, you will see this message:
If your patient should not have HbA1c used for diagnosis, you will see a message similar to this (it will tell you why the HbA1c result should not be used):
Once the protocol has checked that the HbA1c is appropriate for diagnosis, it then looks at a number of different factors and gives you information based on this:
- Is the patient diabetic and coded appropriately?
- Is the patient diabetic and not coded/diagnosed?
- Is the patient pre-diabetic and coded appropriately?
- Is the patient pre-diabetic not coded/diagnosed?
- Does the patient have a history of gestational diabetes and need ongoing monitoring?
- Does the patient have normal glycaemic control currently?
Diabetic patients coded appropriately
For diabetic patients, the protocol will highlight a number of different pieces of information:
- if they have a personal HbA1c target set
- their latest HbA1c
- their penultimate HbA1c
- If they are taking hypoglycaemics such as insulin, SUs or newer agents
- If they are on metformin
Diabetic patients and not coded/diagnosed
Where an HbA1c is above 48, the protocol will look at if this is the first or the second time that this has occurred; displaying the following information:
Prediabetic and appropriately coded
If this is the case an alert box will inform you of the following information:
Prediabetic and not coded
The protocol will show you the latest HbA1c, advise your team to book with a nurse to discuss pre-diabetes lifestyle measures, and offer to code the patient with "Pre-diabetes":
If the HbA1c is completely normal, and there is no history of pre-diabetes or gestational diabetes the following information will be shown to the user: