HbA1c result decision support (HP064)

HbA1c result decision support (HP064)

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

This option on the OneLauncher Prescriber gives the user a very helpful way of checking the latest HbA1c result and understanding what this means for the patient they are reviewing.  
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.

Functions that the protocol performs

The protocol performs the following actions:
  1. Checks that an HbA1c is appropriate for diagnosis
  2. 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:
  1. eGFR<30
  2. Systemic steroids in the last 3 months
  3. Aged under 30
  4. Iron deficiency anaemia
  5. last Hb <110
  6. Haemolytic anaemias
  7. Alcoholism
  8. Liver disease
  9. Pernicious anaemia
  10. Pregnancy
  11. 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):


Information to help you interpret the HbA1c result

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:
  1. Is the patient diabetic and coded appropriately?
  2. Is the patient diabetic and not coded/diagnosed?
  3. Is the patient pre-diabetic and coded appropriately?
  4. Is the patient pre-diabetic not coded/diagnosed?
  5. Does the patient have a history of gestational diabetes and need ongoing monitoring?
  6. 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:
  1. if they have a personal HbA1c target set
  2. their latest HbA1c
  3. their penultimate HbA1c
  4. If they are taking hypoglycaemics such as insulin, SUs or newer agents
  5. 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":



Normal HbA1c

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:


If the HbA1c is normal, but the patient has previously been coded as "High risk of diabetes" or "Pre-diabetes" the following information will be shown:

If the HbA1c is normal, but the patient has previously had gestational diabetes (and isn't coded as "High risk of Diabetes", the following will be shown:
















Communications log

Do you want your teams to be able to interpret HbA1c results with ease whilst working through pathology results? Have you thought about delegating certain blood results to other team members? Have a look at our HbA1c interpretation decision support tool. This will help your teams decide if an HbA1c can be used for diagnosis and then give them information about the result to show if the patient has the correct diagnoses recorded, or how their control is looking.


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