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Is Australia ready to use glycated haemoglobin for the diagnosis of diabetes?

Jonathan E Shaw, Michael C d’Emden and Ian Goodall, On behalf of the Joint HbA1c Working Party of the Australian Diabetes Society, the Royal College of Pathologists of Australasia, and the Australasian Association of Clinical Biochemists
Med J Aust 2011; 195 (1): . || doi: 10.5694/j.1326-5377.2011.tb03178.x
Published online: 4 July 2011

HbA1c may be a practical alternative to blood glucose for the diagnosis of diabetes

For more than 15 years, glycated haemoglobin (HbA1c) has been recommended as the key tool for assessing glycaemic control in people with diabetes. Only in 2009 did the first advice to use HbA1c levels for diabetes diagnosis appear, using a cut-point of ≥ 6.5%.1 To date, no clear argument has been articulated to explain why HbA1c levels have been deemed superior to laboratory-determined blood glucose levels for determining the need for insulin therapy, but not for diagnosing diabetes; however, it is likely that implications of the former are greater than those of the latter, for both individuals and society.


  • 1 Baker IDI Heart and Diabetes Institute, Melbourne, VIC.
  • 2 Department of Endocrinology and Diabetes, Royal Brisbane and Women’s Hospital, Brisbane, QLD.
  • 3 Special Chemistry, Austin Pathology, Austin Health, Melbourne, VIC.



  • 1. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32: 1327-1334.
  • 2. Kirkman MS, Kendall DM. Hemoglobin A1c to diagnose diabetes: why the controversy over adding a new tool? Clin Chem 2011; 57: 255-257.
  • 3. Little RR, Rohlfing CL, Sacks DB; National Glycohemoglobin Standardization Program (NGSP) Steering Committee. Status of hemoglobin A1c measurement and goals for improvement: from chaos to order for improving diabetes care. Clin Chem 2011; 57: 205-214.
  • 4. RCPA Chemical Pathology Programs. Program information circular: glycohaemoglobin program, whole blood samples, 22/06/09. http://www.rcpaqap.com.au/chempath/documents/uploadedfiles/455_Whole%20Blood%20Samples%20270809.pdf (accessed Mar 2011).
  • 5. Colagiuri S, Lee C, Wong T, et al. Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes. Diabetes Care 2011; 34: 145-150.

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