An asymptomatic 50-year-old man has a single HbA1c of 51 mmol/mol on screening. What should happen?
Answer and explanation
Correct answer: D. Repeat the HbA1c to confirm the diagnosis
- Step 1: The diagnostic threshold is 48 mmol/mol, but an asymptomatic person needs a confirmatory result.
- Step 2: WHO and NICE advise repeating the test in an asymptomatic person; symptomatic people can be diagnosed on a single result.
Answer
Repeat the HbA1c to confirm the diagnosis.
Why not the others: Arrange a fasting lipid profile and use it to decide whether diabetes is present: Lipids do not confirm diabetes. Reassure him that the result is in the normal range and recheck in five years: 51 is above the 48 threshold, so it is not normal. Start metformin 500 mg daily straight away without any further test being done: Treating before confirmation is premature.
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