Role Of HbA1c Research Articles

Large-Scale DNA Methylation Profiling of Human Diabetic Peripheral Neuropathy in Subjects with Type 2 Diabetes Mellitus

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes. Emerging evidence suggests that aberrant DNA methylation may play a critical role in the pathogenesis of diabetic complications. Yet, its involvement in DPN is not fully characterized. In this study, we performed a large-scale genome-wide methylation profiling of sural nerve samples obtained from subjects with type 2 diabetes mellitus (T2DM) using Reduced Representation Bisulfite Sequencing (RRBS). A total of 78 samples were sequenced and mapped to the human reference genome. Differential analysis was performed on two groups, identified by our previous transcriptomic analysis of the same samples, which showed significantly different HbA1c levels: Group 1 (=8.5%±1.6%) and Group 2 (<7.0%±1.4%). Using MethylKit R package, with an adjusted p-value < 0.01 and 15% methylation change as significance cutoffs, we identified 2,066 differentially methylated CpG sites and 440 regions, corresponding to 1,519 and 429 unique differentially methylated genes (DMGs). These genes were highly enriched in biological processes related to nervous system development, neuron fate specification and neuron differentiation. KEGG pathway enrichment analysis demonstrated that genes involved in cancer, ECM-receptor interaction and axon guidance pathways were significantly differentially methylated between the two groups, highlighting the importance of DNA methylation in DPN pathogenesis. In summary, we demonstrate that type 2 diabetic patients with peripheral neuropathy and high HbA1c show distinct variations in sural nerve methylome, suggesting that DNA methylation and DPN are associated and that these associations are at least in part HbA1c-dependent. Our results provide new insights into the role of HbA1c in epigenetic variation, and identify candidate genes relevant to the pathogenesis of DPN in human sural nerves of subjects with T2DM. Disclosure K. Guo: None. S. Elzinga: None. S. Eid: None. C. Figueroa-Romero: None. B.A. McGregor: None. G. de Anda-Jáuregui: None. C. Pacut: None. E.L. Feldman: None. J. Hur: None.

The Role of HbA1c on Mortality in Patients with Medical History of Ischemic Stroke and Paroxysmal Atrial Fibrillation

Objective: The correlation of HbA1c level with mortality in patients with ischemic stroke and Paroxysmal Atrial Fibrillation (pAfib). Method: 278 patients with medical history of ischemic stroke and pAfib confirmed with cerebral Computed Tomography and electrocardiogram or rhythm Holter respectively, were included in the study. All patients visited for routine health screening examination or with minor deseases the departments of internal medicine of three tertiary hospitals. The mean age was 78±12 years. The participants were divited into two groups: In group A, 167 patients (60%) that had diabetes mellitus type II (DMT2) were included. Among them, 92 were women (55%) and 75 were men (45%). The remaining 111 patients (58 women (52%) and 53 men (48%)) had no medical history of DMT2, and were included in group B. Among others, HbA1c was measured in all patients in months 6,12,18,24,36 and a survival/ events follow-up was recorded. The study duration was 36 months. Results: In group A, 20 deaths of patients (12%) were reported, among them 8 were men (40%) and 12 were women (60%) with average HbA1c measurements during the follow-up period: 2 patients (10%) with 6,5<HbA1c<7, 6 patients (30%) with 7<HbA1c<8,5 and 12 patients (60%) with HbA1c>8,5. In group B, 10 deaths (9%) were reported. Among them, 4 men (40%) and 5 women (60%) with measurement 6<HbA1c<6,5 and 1 woman (10%) with HbA1c<6. The mortality for patients with ischemic stroke and pAfib is increased with the increase of HbA1c in patients with DMT2 in a statistically significant manner (p 0.0031). An non-statistically significant increase in mortality was also observed in group B. (p 0.22). Conclusion: The increase in the level of HbA1c increases the mortality in patients with ischemic stroke and pAfib especially in those with DMT2. Disclosure K. Kanellopoulou: None. I.L. Matsoukis: None. A. Ganotopoulou: None. T. Athanasopoulou: None. C. Triantafillopoulou: None. A. Sianni: None.

SAT-215 - The role of HbA1c as a risk factor for the development of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis

SAT-215 - The role of HbA1c as a risk factor for the development of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis

Evaluation of the Role of HBA1c in Chronic Kidney Disease

Evaluation of the Role of HBA1c in Chronic Kidney Disease

THE ROLE OF GLYCATED HEMOGLOBIN IN THE DIAGNOSIS AND IMPROVED PROGNOSIS OF DIABETES MELLITUS

The focus on the problem of diabetes mellitus (DM) is associated with the increasing prevalence of the disease and the risk for the development of many vascular complications (nephropathy, retinopathy, lesions of the great vessels of the heart, brain, peripheral vascular disease of the lower limbs), in the development of which chronic hyperglycemia plays a crucial role. In 2011, the WHO decided that glycated hemoglobin (HbA1c) could be used as the diagnostic criterion for diabetes. The role of HbA1c in the choice of hypoglycemic therapy is invaluable. According to the Algorithms of Specialized Medical Care for Diabetes Mellitus Patients, stratification of treatment strategy in patients with newly diagnosed type 2 diabetes is determined by the initial HbA1c.

Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients.

We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated. A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF. Serum level of HbA1c could not be used as a predictor for the development of POAF.

Role of HbA1C and OGTT in diagnosing diabetes mellitus

Role of HbA1C and OGTT in diagnosing diabetes mellitus

The role of HbA1c as a diagnostic test for type 2 diabetes mellitus in Bangladesh

Background: Type 2 diabetes mellitus is a serious chronic disease with microvascular complications such as retinopathy, nephropathy and neuropathy and macrovascular complications such as cardiac, peripheral arterial and cerebrovascular disease. Objective: The aim of the study was to investigate the value of HbAlc as a diagnostic test for type 2 diabetes mellitus in Bangladeshi inclividuals. Methods: This cross sectional study was conducted in the Department of Biochemis­try, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total 657 patients, who were attended in the one point sample collection centre of Bangabandhu Sheikh Mujib Medical University for oral glucose tolerance test (OGIT) from 1st April 2014 to 30th June 2014, were purposively enrolled in this study. According to WHO criteria and based on OGIT findings study subjects were categorized into Normoglycemic (257), IFG (82), IGT (174), and DM (347). Fasting plasma glucose. HbA1c and plasma glucose at 2 hour after glucose load on OGIT was done from all the study subjects. Results: With a cut-off value of 6.J %, HbAlc had a maximal sensitivity and specificity of 97.0% and 49.0% respectively with a positive predictive value 65.5% and a negative predictive value 94.0%. HbA1c had a sensitivity of 93.0% and a specificity of 63.0% was calculated with a cut-off value of 6.5% with positive predictive value 77.5% and negative predictive value 90.0%. Both fasting plasma glucose levels and 2 hour plasma glucose levels were showed significant positive correlation with HbAlc (r = 0.788, P = 0.000 and r = 0.800, P = 0.000 respectively). Conclusion: The study suggests that measurement of HbAlc could be used to make diagnosis of T2DM in the Bangladeshi population.

Role of HbA1c at Admission on Severity and Functional Outcome of Ischemic Stroke in Patients with Diabetes Mellitus

Background: Diabetes mellitus the metabolic disorder can interact with atherosclerosis in ischemic strokes to initiate activate and propagate vascular events. To formulate effective preventive measures, it is mandatory to understand the impact of the glycemic status on the severity and functional outcome of Acute Ischemic stroke in patients with diabetes. Purpose of the study: Study the effect of Glycemic status at admission on severity and outcome of Acute Ischemic stroke in patients with diabetes. Materials and methods: The study is a prospective, case-control, hospital based study done at Department of Neurology, Narayana medical college for a period of 1½ year. Results: 130 acute ischemic stroke patients were studied. 100 patients were cases with diabetes mellitus. Remaining 30 patients were controls without diabetes. Case were subcategorised to good glycemic control (HbA1c 7) 97.5% patients of poor glycemic control group has moderate to severe stroke severity >7 (NIHSS) at admission and 53.3% of good glycemic control patients has mild severity (NIHSS=1-6). 95% of good glycemic control group and 96.7% of non-diabetic control group patients have functional independence at 3 months of follow up. 47.5% of Poor glycemic control patients have functional dependence at 3 months of follow up. Conclusion: Glycemic control has significant association on severity and outcome of ischemic stroke patients with diabetes. Estimation of HbA1c levels at the time of admission might be a predictor of the severity of neurological impairment and functional outcome in patients with acute ischemic stroke and diabetes mellitus.

The Utility of Glycated Hemoglobin, Determined in the Second Trimester of Pregnancy, in Diagnosing Gestational Diabetes

Abstract Background and Aims: Gestational diabetes (GD) identifies a pregnancy with high obstetrical risk due to the possible complications that may appear and which are associated with significant perinatal mortality and morbidity. The role of HbA1c in diagnosing GD is still debatable. Our aim was to evaluate the clinical utility of HbA1c assessed in the second trimester of pregnancy (before performing the oral glucose tolerance test - OGTT) in establishing the macrosomia risk, and also for diagnosing GD. Material and methods: This was an observational study on a group of 165 pregnant women followed from the first trimester of pregnancy in whom we measured HbA1c in the second trimester, before running an OGTT with 100 grams of glucose and who delivered at term (37 - 41 weeks of pregnancy). Finally, HbA1c and OGTT were performed only in 132 women, these being the subjects of our study. Results: The average value of HbA1c was 4.85±1.23%. HbA1c was higher in the group having gestational diabetes (6.58±0.74%) in comparison to the group not having GD (4.52±0,80%). The Receiver Operating Characteristic (ROC) curve for HbA1c determined in the second trimester, for diagnosis of GD, has an area under the curve (AUC) of 0.939. Conclusions: HbA1c value could be considered as a sensitive and specific predictive factor in appreciating the macrosomia risk and could be set as an extra criterion in GD diagnosis.

Type 2 diabetes: recent advances in diagnosis and management

The expanding array of new type 2 diabetes agents and how to combine them effectively is complex. This review gives an overview of the newer therapies and their current place in type 2 diabetes management. It also examines the role of HbA1c in the screening and diagnosis of those at risk of diabetes.

Updated guidelines on screening for gestational diabetes.

Gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period. Screening and identifying these high-risk women is important to improve short- and long-term maternal and fetal outcomes. However, there is a lack of international uniformity in the approach to the screening and diagnosis of GDM. The main purpose of this review is to provide an update on screening for GDM and overt diabetes during pregnancy, and discuss the controversies in this field. We take on debatable issues such as adoption of the new International association of diabetes and pregnancy study groups criteria instead of the Carpenter and Coustan criteria, one-step versus two-step screening, universal screening versus high-risk screening before 24 weeks of gestation for overt diabetes, and, finally, the role of HbA1c as a screening test of GDM. This discussion is followed by a review of recommendations by professional bodies. Certain clinical situations, in which a pragmatic approach is needed, are highlighted to provide a comprehensive overview of the subject.

Role of HbA1c in predicting risk for congenital malformations

AimsAssociation between conventionally identified hyperglycemias and rates of congenital abnormalities is known; however there is less information about role of HbA1c in determining gestational hyperglycemias and associated risks.This study tried to explore the association between HbA1c in women without known diabetes at first antenatal visit and risk of congenital malformations (CM) among Saudi women living at Al-Madinah Al-Monawarah. MethodsEleven hundred and eighty (1180), healthy, first-trimester pregnant Saudi females without known diabetes, were selected from various antenatal care clinics of Al-Madinah Al-Monawarah city. General clinical and biochemical data was collected for this study by researchers at first visit and the time of delivery. ResultsNearly one fifth (19.6%) of mothers had above normal HbA1c (>5.7) at first visit. Rates of CM had significant positive association with level of HbA1c. Rate of CM among those who had HbA1c in diabetes range, pre-diabetes range or normal range was 27.8%, 9.8% and 3.0%, respectively. The difference was significant between normal and pre-diabetes at the level P=0.000 and between pre-diabetes and diabetes at level P=0.038. ConclusionIn this study HbA1c is found to be a valuable predictor of risk of congenital malformations. This observation calls for further studies and establishment of policies for care of pregnant mothers having higher than normal HbA1c at first visit.

Role of HbA1c in post-partum screening of women with gestational diabetes mellitus

AimTo compare the performance of HbA1c with established glucose criteria during an oral glucose tolerance test (OGTT) and to assess HbA1c as a screening test for undiagnosed diabetes and pre-diabetes after gestational diabetes mellitus (GDM). MethodsGlucose homeostasis was re-evaluated 1–5 years after delivery in 140 women with previous GDM, by means of OGTT and simultaneous HbA1c measurement. Glucose tolerance was defined according to World Health Organisation criteria. HbA1c ≥6.5% (≥48 mmol/mol) was used for diabetes diagnosis and HbA1c ≥5.7% (≥39 mmol/mol) to define abnormal glucose homeostasis. ResultsHbA1c had low sensitivity (14.3%) and high specificity (99.1%) in diabetes diagnosis. Sensitivity and specificity of HbA1c to detect abnormal glucose tolerance were 29.5% and 95.2%, respectively. The consistency in classifying abnormal glucose tolerance between HbA1c and OGTT criteria was 59% (κ = 0.227) and the area under the receiver operating characteristic curve was 0.708. The combined use of HbA1c and fasting glucose criteria showed similar performance to that of fasting glucose criteria alone. The latter identified 63% of the women with pre-diabetes or diabetes in the study cohort. However, by lowering the cut-point of HbA1c to ≥5.0% (≥31 mmol/mol), an additional proportion (27%) with isolated post-glucose load hyperglycaemia was identified. ConclusionProposed thresholds of HbA1c had low diagnostic sensitivity. Combined with a fasting glucose test, the performance was no better than with using a fasting glucose test alone. Combining a fasting glucose test with a lower HbA1c cut-point may be an alternative approach for selection of women for an OGTT.

MP69-10 GLYCATED HEMOGLOBIN (HBA1C) LEVELS ARE INDEPENDENTLY ASSOCIATED WITH UNFAVOURABLE PROSTATE CANCER AND DISEASE RECURRENCE AFTER RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: Previous studies have shown that diabetic patients diagnosed with prostate cancer (PCa) and treated with radical prostatectomy (RP) may be at higher risk of harbouring unfavourable PCa at final pathology. We hypothesized that glycated haemoglobin (HbA1c) levels, regardless of a previous diagnosis of diabetes, may be associated with adverse PCa features and higher risk of recurrence after RP. METHODS: The study included 1,249 patients treated with RP for clinically localized PCa between 2008 and 2011 at a single tertiary care center. Pre-operative HbA1c was measured in all patients the day before surgery. Uniand multivariable logistic regression models tested the association between HbA1c and pathological stage, defined as extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node involvement (LNI). Univariable and multivariable Cox regression analyses evaluated the role of HbA1c in predicting biochemical recurrence (BCR), defined as PSA 0.2 ng/ml and rising. Covariates consisted of total PSA at diagnosis, biopsy Gleason sum and clinical stage. HbA1c was tested as both continuous and categorical variable, according to the WHO classification (namely 6.5%) RESULTS: Mean and median pre-operative HbA1c levels were 5.73 and 5.60%, respectively (range 4.0-10.8%). Overall, HbA1c was 6.5% in 643 (51.5%), 500 (40%) and 106 (8.5%) patients, respectively. According to patient medical history, 124 (9.9%) had a diagnosis of diabetes. Mean and median PSA were 12.3 and 6.8 ng/mL, respectively. Clinical stage was T1 in 54.7%, T2 in 30.4% and T3 in 14.9% of the patients. Biopsy Gleason sum was 6 in 58.2%, 7 in 30.1% and 8-10 in 11.7% of the patients. Median follow up was 34 months (range 1-118). At multivariable logistic regression analyses, after adjusting for PSA, clinical stage and biopsy Gleason sum, HbA1c was an independent predictor of SVI (OR 1.43; p1⁄40.003) and LNI (OR 1.38, p1⁄40.01). At multivariable Cox regression analyses, HbA1c categorized according to the WHO definition was independently associated with the risk of BCR (p1⁄40.02), after accounting for confounders. Patients with HbA1c >6.5% had a 2.01 higher risk of BCR as compared to those with HbA1c <5.7%, after accounting for all confounders. CONCLUSIONS: Increased levels of HbA1c are independently positively associated with more adverse pathological features and higher BCR rates. These results should be taken into account when diabetic patients are considered for curative treatments of PCa.

Women with a nondiagnostic 75 g glucose tolerance test but elevated HbA1c in pregnancy: An additional group of women with gestational diabetes

We examined whether pregnant women with a normal glucose tolerance test (OGTT) by New Zealand (NZ) criteria, but elevated HbA1c are a clinically important group with gestational diabetes (GDM). Eighty women with a normal OGTT and HbA1c>40mmol/mol, compared with others with GDM, had a significantly higher BMI and were more likely Pacific. Pharmacotherapy was prescribed in 77.5%. Post-partum OGTT and HbA1c were abnormal in 9/43(20.9%) and 27/42(64.3%), respectively. In 1090 women being screened for GDM by OGTT, most women with GDM had an HbA1c≤40mmol/mol. In the 22.1% of women with an HbA1c>40mmol/mol, the OGTT was normal in 61.8%. For centres using HbA1c to screen for underlying prediabetes/diabetes, these data show that a result >40mmol/mol identifies women who are likely to require pharmacotherapy. An OGTT is still recommended to diagnose GDM, but these data raise questions about a possible role for HbA1c in high risk women with a nondiagnostic OGTT.

Glycosylated hemoglobin as a predictor for the occurrence of macroangiopathic complications in diabetic patients from bihor county

Abstract Background and Aims: Prospective studies showed that long-term hemoglobin A1c (HbA1c) levels correlate directly with the risk of developing and progression of diabetic complications. The aim of the study was to evaluate the correlation between metabolic control and HbA1c variability with macrovascular complications and assess the role of HbA1c as an independent predictive factor for the occurrence of macrovascular complications in diabetic patients from Bihor County, Romania. Material and method: The study was conducted for a 5 years period (2007-2011) and included 321 diabetic patients with no evidence of macroangipathic complications. During the follow-up all the major vascular events were recorded. Results: At the end of the study a total of 85 chronic macrovascular complications were reported. Distribution plots show significantly higher incidence of vascular complications in patients in the group with poor glycemic control. Multivariate analysis showed that HbA1c can be considered an independent predictor of atherosclerotic complications as well as atherosclerotic complications risk score. The variability of HbA1C was not an independent predictor for macroangiopathic complications (p=0.78). Conclusions: Overall glycemic control was the most important factor in the progression of atherosclerosis but we could not rule out that glycemic variability might play a role in the development of complications in type 2 diabetes mellitus (T2DM) patients.

Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery?: Table 1:

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is there a role for HbA1c in predicting morbidity and mortality outcomes after coronary artery bypass surgery? Eleven studies presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The studies presented analyse the relationship between preoperative HbA1c levels and postoperative outcomes following coronary artery bypass graft (CABG) in diabetic, non-diabetic or mixed patient groups. Four studies found significant increases in early and late mortality at higher HbA1c levels, regardless of a preoperative diagnosis of diabetes. One study demonstrated that 30-day survival outcomes were significantly worse in patients with previously undiagnosed diabetes and elevated HbA1c compared with those with good control [HbA1c >6%; odds ratio 1.53, confidence interval (CI) (1.24-1.91); P = 0.0005]. However, four studies of early mortality outcomes in diabetic patients only showed no significant differences between patients with normal and those with deranged HbA1c levels (P = 0.99). There were mixed reports on morbidity outcomes. Three studies identified a significant increase in infectious complications in patients with poorly controlled HbA1c, two of which were irrespective of previous diabetic status [deep sternal wound infection (P = 0.014); superficial sternal wound infection (P = 0.007) and minor infections (P = 0.006) in poorly controlled diabetics only]. Four studies presented outcomes for total length of stay (LOS). Three of these papers looked specifically at diabetic patients, of which two found no significant differences in length of stay between good and poor preoperative glycaemic control [LOS: P = 0.59 and 0.86 vs P < 0.001]. However, elevated HbA1c vs normal HbA1c was associated with prolonged stay in hospital and in intensive care unit (ICU) in patients irrespective of previous diabetic status [total LOS (P < 0.001)]. Elevated HbA1c levels were also a significant predictor of reduced intraoperative insulin sensitivity in diabetic patients (R = -0.527; P < 0.001). Furthermore, higher HbA1c levels were associated with a reduced incidence of postoperative atrial fibrillation (P = 0.001). We conclude that elevated HbA1c is a strong predictor of mortality and morbidity irrespective of previous diabetic status. In particular, the mortality risk for CABG is quadrupled at HbA1c levels >8.6%. Some studies have called into question the predictive value of HbA1c on short-term outcomes in well-controlled diabetics; however, long-term outcomes in this population have not been reported.

Predictive value of glycosylated hemoglobin on cardiovascular outcomes in prediabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background: Prediabetes is well known to have a substantially greater cardiovascular risk as a result of insulin resistance, dysglycemia, dyslipidemia, hypertension, endothelial dysfunction or inflammation shown as in diabetes mellitus. Previous studies demonstrated impaired glucose tolerance and/or impaired fasting glucose are strong predictors of adverse outcome in acute coronary syndrome. However, the prognostic value of glycemic controlled level, determined by glycosylated hemoglobin (HbA1c), in prediabetic patients with ACS is still undefined. The aim of this study was to demonstrate the role of HbA1c at admission on major adverse cardiac events (MACE) in prediabetic patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: Using data from Korea Working Group on Myocardial Infarction (Kormi; February 2008-December 2011), this observational study included 1,536 patients who had not been diagnosed with DM before or after admission (HbA1c at admission less than 6.5%) with STEMI undergoing primary PCI. Patients were divided into two groups based on HbA1c at admission: non-diabetic (HbA1c≤5.6%, n=607, 39.5%) and pre-diabetic group (5.7%≤HbA1c≤6.4%, n=929, 60.5%). Results: One-year cumulative MACE which was defined as a composite of mortality, nonfatal MI, repeated PCI or coronary artery bypass graft, was not different between two groups (7.4% vs 9.4%, p=0.182). After multivariate logistic analysis, HbA1c was not associated with occurrence of MACE (OR 1.009, 95% CI 0.579-1.759, p=0.975). We conducted subgroup analysis and divided pre-diabetic patients into two groups by the HbA1c level of 6.0%. Both of one-year cumulative MACE (11.1% versus 7.5%) and OR for MACE were lower (OR 0.586) in patients with higher HbA1c level, but did not show any statistical significances, either. Conclusion: This study demonstrated HbA1c level at admission was not significantly associated with cardiovascular outcomes in prediabetic Korean populations with STEMI undergoing primary PCI.

The role of HbA1c in the diagnosis of diabetes mellitus in Australia

For many years, the diagnosis of diabetes has been made through the laboratory-based measurement of fasting or random blood glucose levels, or using the oral glucose tolerance test. A glycated haemoglobin (HbA(1c)) level ≥ 6.5% (48 mmol/mol) is now also acceptable for diagnosing diabetes. Caution is needed in interpreting HbA(1c) test results in the presence of conditions affecting red blood cells or their survival time, such as haemoglobinopathies or anaemia.