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HbA1c - what does this mean

  • What is the HbA1c and complications screening 

    Every 3 – 4 months, children and adolescents with type 1 diabetes will have a blood test called an HbA1c. These blood tests measure the amount (as a percentage) of haemoglobin in red blood cells that has glucose attached to it.  The higher the glucose levels in the blood (the more BGLs out of target per day/week) the more will become attached to the haemoglobin. The HbA1c test is the best measure of long-term blood glucose control. It gives a measure of the overall glucose control over the last 2-3 months and provides important information  about the relative risk of complications associated with long term elevated blood glucose levels.

    The target HbA1c for children and adolescents is 7% or less or less than 53 mmol/mol. If a child has any HbA1c higher than this on a regular basis, their risk of developing complications will increase dramatically.

    Throughout a lifetime insulin requirements will change and doses will need to be adjusted accordingly in order to keep blood glucose levels within the target range.

    Growth, sport, activity, lifestyle, and food all play a part in affecting BGLs. 

    Haemoglobin

    Remember: BGLs in the target range of 4 - 7 mmol/L = HbA1c in target range

    The goal of diabetes care is to enjoy a long and healthy life and to enjoy regular day to day activities whilst minimising the risk of long-term diabetes related complications. We do this by encouraging regular reviews of BGL’s, adjusting insulin doses in response to patterns and performing the HbA1c test every 3-4 months in diabetes clinic.

    Targets can be achieved by ongoing contact with a dedicated paediatric diabetes care team, education and motivation to maintain a healthy lifestyle with particular emphasis upon diet and exercise. The diabetes team can teach you how to adjust your child’s insulin and support you to become independent with this over time.

    The HbA1c test is the best measure for long-term blood glucose control. It can tell us about how much glucose has been circulating in the blood stream on average over the last three months which tells us about the relative risk of complications associated with chronically (long term) elevated blood glucose levels. (See graph below)

    Complications graph

    Complication screening clinic at the Royal Children's Hospital 

    Diabetes Complication Screening is offered to children and adolescents with diabetes as a routine screening tool. Screening allows for the detection of very early signs of complications, where changes can be put in place to stop or reverse that complication.

    The Diabetes Complication Screening Clinic assessments includes a photo of the back of the eye, to check for nerve damage to the eyes, blood tests to screen lipids, coeliac, thyroid and thyroxine levels and a urine test to check kidney function, a postural blood pressure and an assessment of peripheral neuropathy.  

    Your doctor has to refer you child to the Diabetes Complication Screening Clinic. Usually the screening appointment will be booked in alongside your next endocrinology appointment. At times, there can be waiting list, if this is the case it will be booked in alongside your appointment in 6 months’ time.  

    When should my child be getting Diabetes Complication Screening at RCH?

    If diagnosed with diabetes under the age of 10 years old first diabetes complication screening at approximately 5 years after diagnosis. And then every 2 years until 15 years old and then annually.

    If diagnosed over 10 years of age, first comps screen approximately 3 years after diagnosis, every two years until 15 and then annually.

    Who organises when my child needs a complication screening?

    Your Endocrinologist will refer your child to the Diabetes Complication Screening Clinic. It will be booked in alongside your next diabetes appointment, on either a Tuesday or a Wednesday afternoon.

    How will I get notified of my appointment?

    An appointment letter with instructions will be sent to your home address. As part of the screening, your child will need to get a sample of the first urine of the day. The reason for this is that an early morning sample gives a much more accurate result than one done during the day. If you forget to do the morning sample a midday sample can still be used. You can collect a yellow collection container from your local pharmacy or pathology. You can keep it in the fridge at home until the appointment. 

    What happens when my child gets their Diabetes Complication Screening?

    Your blood tests will be ordered and waiting for you at pathology (A6) where you usually get your HbA1c. Please do not use a kiosk to check in. Remember to tell the check in personal that your child is having a Complication Screening which requires a blood test.

    What tests are done as part of the Diabetes Complication Screening?

    • Urine test to check the amount of protein being passed via the kidneys into the urine
    • Blood test to check blood lipids, thyroid function and coeliac antibodies
    • Blood pressure both lying and standing
    • Vision testing including retinal photo and a visual acuity assessment
    • Nerve testing of the foot

    My child has been asked to do 3 early morning urine samples- what does this mean?

    It is very common to have mildly increased levels in your urine if the test is done from a midday sample. If this happens we need to check the levels more closely and we will mail out a request for your child to get three early morning samples to check if it is a consistent result. On your appointment letter there is instructions about getting a sample from the first urine of the day.

    When do I get the results?

    Your endocrinologist will go through the results with you at your next appointment.