• Exception reporting codes - go to this
• Rationale - go to this

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

Serum fructosamine codes (Added in the last 15 months)

44TD. Fructosamine level

44Z1. Serum fructosamine

44Z10 Corrected fructosamine

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

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.

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