Age must be 17 or over with a diagnostic code for diabetes mellitus

HbA1c codes (Added in last 15 months)

42W.. Hb. A1C - diabetic control: 42W1. Hb. A1C < 7% - good control; 42W2. Hb. A1C 7-10% - borderline; 42W3. Hb. A1C > 10% - bad control; 42W4. HbA1c level (DCCT aligned); 42WZ. Hb. A1C - diabetic control NOS
42c.. HbA1 - diabetic control: 42c0. HbA1 < 7% - good control; 42c1. HbA1 7 - 10% - borderline control; 42c2. HbA1 > 10% - bad control; 42c3. HbA1 level (DCCT aligned)
44TB. Haemoglobin A1c level
44TC. Haemoglobin A1 level
44TL. Total glycosylated haemoglobin level

OR

IFCC HbA1c code

42W5. Haemoglobin A1c level - International Federation of Clinical Chemistry and Laboratory Medicine standardised

Diabetes exception reporting codes (Added in the last 15 months)

9h4.. Exception reporting: diabetes quality indicators: 9h41. Excepted from diabetes quality indicators: Patient unsuitable; 9h42. Excepted from diabetes quality indicators: Informed dissent; ~~9h43. Excepted from diabetes quality indicators: service unavailable (v18)~~

DM 5.1 Rationale

HbA1c is a marker of long-term control of diabetes. Better control leads to fewer complications in both insulin dependent and non-insulin dependent patients with diabetes. There is no trial evidence to support the frequency of HbA1c measurement.

Fructosamine may be used in some areas as an alternative to HbA1c or, for example, in some patients with haemoglobinopathies.

In stable patients with diabetes, measurements should be made at six-monthly intervals. Measurement should occur more frequently if control is poor or there has been a change in therapy.

Grade D Recommendation NICE Inherited Guideline G (2002)

For the purposes of contract monitoring the indicator has been set at a minimal level assuming an HbA1c measurement at least annually.

There are proposals to modify the reporting of HbA1c during 2009-2010, so that results are also reported in mmol/mol. However laboratories will continue to report using the current percentage figure until April 2011. The QOF criteria for 2009-2010 are therefore based on the current arrangements to report HbA1c as a percentage figure.

DM 5.2 Reporting and verification

The practice should report the percentage of diabetic patients who have had an HbA1c or equivalent in the previous 15 months.

In verifying that this information has been correctly recorded, a number of approaches could be taken by a PCO:

i. inspection of the output from a computer search that has been used to provide information on this indicator
ii. inspection of a sample of records of patients with diabetes to look at the proportion with recorded HbA1c in last 15 months
iii. inspection of a sample of records of patients for whom a record of HbA1c is claimed, to see if there is evidence of this in the medical records.

Prepared By Jean Keenan