Exclusive - Test switch will double diabetes cases

DoH plans to move to HbA1c raises fears of inequality in vascular screening.

GPs face having to treat twice as many patients for diabetes under the health checks programme as originally planned, because the DoH is considering basing diagnosis on the more accurate HbA1c test.

But patients who have already received a health check will not be retested, in a move that could intensify inequalities across England.

The majority of PCTs across the country have now begun rolling out the checks, with some offering them from as early as January this year.

Currently, these PCTs are following guidance which states that 'a fasting plasma glucose (FPG) test is recognised as an acceptable first test to identify those with potential diabetes or at high risk'.

However, studies have shown that introducing HbA1c testing could help to identify twice as many cases of diabetes as FPG. In 2007/8 there were 126,359 new diabetes diagnoses. This could double to more than 250,000 if HbA1c tests were used.

The test is also more accurate at picking up diabetes among South Asians, a population six times more likely to develop the condition than Caucasians.

Dr Terry McCormack, former chairman of the Primary Care Cardiovascular Society, told GP that it was likely the UK would now adopt HbA1c testing.

'This will cause problems for PCTs, particularly those with high deprivation and ethnic minority populations, that have already begun their health checks and are not using HbA1c testing,' he warned.

Professor Kamlesh Khunti, an adviser to the DoH health-checks programme, said that new patients would be classified with the new test, but that GPs would not go back and retest patients who had been tested using FPG.

'HbA1c is definitely a better test for diabetes as it is a much better marker for cardiovascular outcomes,' he said.

'It is also a more convenient test as patients do not have to fast before taking it.'

Dr Brian Karet, diabetes lead for Bradford PCT, said: 'HbA1c is a more accurate way of diagnosing diabetes that is good for all populations. FPG tests are not good for South Asian populations.

'More patients will be diagnosed using this test. Prevalence of diabetes will go up, particularly in areas with a high population of ethnic minorities.'

He added that introducing HbA1c testing would also move more patients with impaired glucose tolerance into the diabetes diagnostic category.

Diabetes UK confirmed that discussions about changing diagnostic criteria were ongoing, with a decision imminent.

A spokesman for the DoH added that the department was awaiting a decision from the WHO before announcing any change to HbA1c testing.


Diabetes tests

  • DoH is considering a move from FPG testing to HbA1c.
  • Diabetes UK has confirmed discussions are ongoing and a decision is imminent.
  • HbA1c testing is likely to identify twice as many cases of diabetes as FPG.
  • Patients of South Asian origin with diabetes are more likely to be detected by the HbA1c test.

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