Hyperglycaemia - Initial Assessment

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Indication

Test as per DAME Reference Chart
Fasting glucose 5.5mmol/L or more
See below for action on HbA1c 6.5% [48mmol/mol] or over

Procedural requirements

75g glucose tolerance test following overnight fast

Interpretation

HbA1c 6.5% [48mmol/mol] or over: assess as Diabetic
2hr glucose >11mmol OR Two fasting glucose readings > 7mmol: assess as Diabetic
2hr glucose between 7.8 and 11: assess as Impaired Glucose Tolerance (IGT)
2hr glucose less than 7.8mmol and fasting glucose >6mmol: assess as Impaired Fasting Glucose (IFG)
ROLE of GTT and HbA1c: HbA1c levels have been validated in the diagnosis of diabetes. They have not been adequately validated in the estimation of cardiovascular disease risk, and cannot determine IFG and IGT, where elevated CVD risk also needs to be considered. For this reason, GTT remains the risk stratification tool where there is non-diabetic hyperglycaemia.

Further Actions

Diabetes require workup as per schedule:
Impaired Glucose Tolerance (IGT)
- Cardiovascular Risk Assessment
- GTT in 12 months
Impaired Fasting Glucose (IFG)
- Cardiovascular Risk Assessment
- Fasting glucose in 12 months

Pilot Information

There is a strong link between abnormalities of glucose metabolism, heart disease and strokes. This includes both diabetes and “pre-diabetes”.

The consequences of heart attacks and strokes are potentially serious.
In addition, abnormal glucose levels can affect many of the body systems such as eyes, kidneys and nerves.
There are well proven ways of managing these risks once they are identified, and so accurate diagnosis is important.

References

Diabetes Management in General Practice 2012/13
Balkau B, Bertrais S, Ducimetiere P, Eschwege E. Is there a glycemic threshold for mortality risk? Dia Care. 1999 May 1;22(5):696-9.

Hyperglycaemia - Initial Assessment flowchart

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A text version of the Hyperglycaemia - Initial Assessment flowchart is also available.

Disclaimer

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer