Impaired Glucose regulation Read code short cut /igr

(formerly ‘IGT’ ‘IFG’)

Now that HbA1c is being used for the screening and diagnosis of diabetes the usual pathway (fasting BS or GTT for the diagnosis of IFG and IGT) has changed. The usual diagnostic pathway for borderline results

HbA1c 42 to 47 mmol/l = Impaired Glucose Regulation = pre diabetes – arrange repeat HbA1c andnon fasting lipid profile for CVD risk assessment. They will need annual HbA1c and CVD risk assessment

Fasting BS 5.5 – 6.9 – arrangerepeat HbA1c and non fasting lipid profile for CVD risk assessment. If HbA1c 42 to 47 mmol/l = Impaired Glucose Regulation.They will need annual HbA1c and CVD risk assessment.

BUT HbA1c should not be used for diagnosis in children, pregnant women, patients’ with haemoglobinopathy. In which case you must revert back to the original diagnostic pathway (Fasting BS 5.5 – 6.9 x 2 = IGR or > 6.9 x2 = DM)

One third of patients with IGR will go on to develop Type 2 diabetes

Patients found to have IGR should:

  1. Have the appropriate Read code /igr entered into their summary and the Problempage.
  2. A GP appointment or Practice Nurse appointment for an explanation of IGR in the context or ‘pre-diabetes’. If aerobic exercise 5 x per week and weight loss of 7% is achieved the risk of progression to DM is reduced by 60%.
  3. Have their non fasting lipids, BMI, smoking status/cessation advice, exercise status and BP checked with CVD risk assessment.
  4. Consider follow up HbA1c after lifestyle interventions (no earlier than 6 months) and if the HbA1c is not falling consider adding an uptitrating course of Metformin to 500mg tds with continued prescribing if HbA1c falls after 6 months. (Reduces CVD risk and progression to DM).
  5. Set up an annual ‘IGR’ recall by tasking Karran - this triggers an annual HCA appt for HbA1c, BP, BMI, smoking status and non fasting lipid profile (assuming no co-morbidity) with subsequent Practice Nurse follow up one week later.
  6. If HbA1c = or > 47mmol/l (assuming they are adults, non pregnant and not anaemic) they have probably progressed to diabetes (WHO January 2011) although it needs confirmation with a repeated test. They then should be placed on the diabetes register and reviewed by their GP.

N.B. HbA1c can’t be used if the patient is a child, pregnant, has anaemia or known haemoglobinopathy – in which case they should have a fasting blood glucose and if this is > 7.0 mmol/l repeat as two results > 7.0 required for the diagnosis of diabetes.

Gestational Diabetes

  1. Read code and promote to a major problem
  2. Task Kattan so that she is aware regards annual recall
  3. Fasting BS at 6 weeks check
  4. There after annual HbA1c for life.

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