Notice of HbA1c diagnostic threshold changes in brief1,2:
- New HbA1c criteria define normal as under 42 mmol/mol, prediabetes as 42-47, and diabetes as 48 or higher; no confirmation is needed if HbA1c is 53 mmol/mol or above.
- Vildagliptin should not be added to dulaglutide, as both act on GLP‑1 pathways.
- In pregnancy, all diabetes medications, including ACE inhibitors and statins, are stopped, with only metformin and insulin used, and all pregnant women require secondary care input.
- People with diabetes who also have heart or kidney failure benefit from SGLT2 inhibitors, specifically empagliflozin, in New Zealand.
- Primary care must also address therapeutic inertia and screen for diabetes distress or depression, which can affect glycaemic control.
This Gem has been approved by Dr Helen Snell.
As published in NZ Doctor and Research Review
