Previous articles in this series on improving glycaemic control have discussed the fact that many people with diabetes still do not understand the concept of HbA1c.
“I just don’t understand the role of HbA1c in diabetes control. The doctor just told me whether the test value is high or low but he never explained why.” (Patient on insulin, China, on maintaining a good HbA1c level).
The results of the GTF survey showed that, globally, 51% of people with diabetes had never heard of HbA1c, and nearly half were unaware of their target level. Specifically in the UK, 61% had never heard of HbA1c.
I know that I usually discuss HbA1c results with patients, and I also know how many people continue to suggest they have never heard of it or do not understand it! Yet this measurement remains our reference point in the management of diabetes, and therefore it is important to help patients understand the significance of this test.
Healthcare professionals describe HbA1c as an average blood glucose level but this rarely equates to the readings on a patient’s monitor – because the number ranges of HbA1c and blood glucose appear similar, the fact that they are completely different scales is poorly understood. So people with an HbA1c of 8% may deem this to be reasonable as the message ‘single figures are good’ seems to stick.
Generally, the HbA1c number is given alongside the target. For example, ‘your HbA1c is 9% and the target is 7%’ so patients have some idea how close it is to target. But patients will also need to know what ‘bad’ looks like so they can put the number in context.
Does a patient understand when we talk about the importance of a 1% drop? In other contexts 1% is completely different and, generally, small.
I have found using the chart below an extremely useful tool used in consultations to help patients avoid the confusions discussed above.