HbA1C contraindicated for diagnosis:

 Gestational Diabetes
 CKD
 Iron deficiency Anemia
 Children
 Patient taking drugs causing hyperglycemia (Steroid)
 Hemoglobinopathies
 Hemolytic anemia
HbA1C: 6.5-7.5 %: Start Metformin/ Single Drug therapy
HbA1C>7.5%: Dual Drug Therapy
Monitor with HbA1C:
3-6 monthly: Until Stable RBS
6 monthly: After Stable RBS.

HbA1C RBS mmol/l

5 5.5
6 7.5
7 9.5
8 11.5
9 13.5
10 15.5
11 17.5
12 19.5
Rule:
Averge RBS = (2 X HbA1C) – 4.5

 HbA1C <9%: Start with NPH insulin

 HbA1C >9%: Premixed Insulin
 Insulin Glargine: If patient needs once daily/ No caregiver.

Alteration of HbA1C:
 HbA1C higher than expected HbA1C Lower than expected
 B12, Folic acid deficiency  Sickle cell anemia
 Iron deficiency  G6PD deficiency
 Splenectomy  Hereditary Spherocytosis

Importance of Impaired Glucose Tolerance (IGT):

Next Step always OGTT. Confirmed by OGTT.
Weight gain is a common problem with:
 Insulin
 Sulfonylurea
 Thiazolidandiones
Weight loosing drugs:
 GLP 1: Exenatide (Best)
 Metformin