Diagnosis of Diabetes Mellitus

Conventionally diabetes mellitus was diagnosed by high fasting or random blood glucose concentrations, or an abnormal oral glucose tolerance test (OGTT) whilst haemoglobin A1c (HbA1c) was used to monitor longer term glycaemic control in patients with known diabetes mellitus.

In 2011, the World Health Organisation (WHO 2011) recommended that HbA1c measurements should also be used to diagnose diabetes in the majority of asymptomatic individuals, and this recommendation has been agreed in the UK (NHS Diabetes 2011).

An HbA1c of 48 mmol/mol or more is consistent with diabetes. If the patient has no symptoms then a second HbA1c result must be obtained within 2 weeks, and if it remains ≥48 mmol/mol diabetes mellitus is confirmed.

HbA1c values of 42 to 47 mmol/mol suggest a high risk of future diabetes. Such individuals should be offered structured lifestyle education and support to delay/prevent development of diabetes, and have an annual HbA1c test.

HbA1c must be measured in an accredited laboratory undertaking recommended quality assurance procedures. Near patient testing is not appropriate when HbA1c is used for the diagnosis of diabetes.

HbA1c is now the preferred method to diagnose diabetes, except in the following situations where this test would be unreliable, and in whom the traditional methods of diagnosis with blood glucose concentrations remain the method of choice:

  • Haemoglobinopathies
  • Increased red cell turnover
  • Anaemia (haemoglobin < 80 g/L)
  • ?Type 1 diabetes or acute onset of symptoms of diabetes
  • ?Gestational diabetes
  • Children and adolescents
  • Patients taking steroids and antipsychotic or other medications that cause a rapid rise in blood glucose

Despite this new approach, if an individual has abnormally high random or fasting blood glucose levels or abnormal OGTT, which would be consistent with diabetes on the traditional criteria, then that patient should be considered to have diabetes irrespective of their HbA1c value. Without symptoms of diabetes two abnormal tests of the same type (two high fasting/random blood glucoses or a diabetic OGTT) are required to confirm diabetes mellitus.

UHB, Clinical Chemistry, Clinical

  • Last updated on .
  • Hits: 2972

Fluid Analysis Guidelines

Below are some guidelines for fluid analyses which may be of clinical value. Please contact the Duty Biochemist on x16543 if more information is required:

Fluid type

Clinical Indication

Analyses available

Specimen Container


Ascitic Fluid

? cirrhotic or malignant


Total protein




Plain universal

Serum albumin should be simultaneously measured for comparison.





Total protein

See comment


Plain universal

For rare instances pH should be collected anaerobically with heparin and then measured in a blood gas analyser using clot filter.

? pancreatic fistula



Plain universal

Serum amylase should be measured.

? tubercular


Fluoride oxalate (grey top)


Chest Drain Fluid

? chylothorax




Plain universal




? bacterial meningitis





Plain universal




Fluoride oxalate (grey top)


? Subarachnoid haemorrhage


Plain universal protected from light

Do not use pod system to send sample to lab.

Serum total protein and bilirubin should be measured simultaneously.

?congenital disorder

?cerebral ischaemia


Fluoride oxalate (grey top)

Sent to BCH Biochemistry.

?brain metastases

AFP, HCG, placental ALP

Plain Universal

Sent to Charing Cross for analysis.

Diagnosis/investigation of inborn errors of neurotransmitter metabolism


See comment

Specific collection requirements  – contact Duty Biochemist on ext. 16543 well in advance of arranging test.

Sent to Neuroimmunology lab, London.

?narcolepsy with cataplexy


Plain Universal

Sent to Immunology, Oxford.



Plain Universal

CSF total protein also required for interpretation.

Sent to Neurometabolic unit, London.

Cyst Fluid

?thyroid tissue/met


Plain universal

Requires discussion with laboratory prior to request (contact Duty Biochemist on ext. 16543)

Drain Fluid

? contains urine



Plain universal

Comparison of fluid urea and creatinine with serum will identify significant contamination with urine

?biliary fistula

Post surgery



Plain universal


Gastric Aspirate

? reflux




Plain universal

Occasionally gastric pH may be requested in patients suspected of intestinal reflux or achlorhydria. Normally the fasting gastric pH is about 1-2.

Pancreatic Cyst Fluid


? Ca pancreas


CA 19-9



Plain universal



Fluoride oxalate (Grey top) required





Pleural Fluid

Four types of fluids can accumulate in the pleural space:

  • Serous fluid (hydrothorax)
  • Blood (haemothorax)
  • Chyle (chylothorax)
  • Pus (pyothorax or empyema)

 ? transudate or exudates


A transudate fluid is produced through pressure filtration without capillary injury while exudate is "inflammatory fluid" leaking between cells.

Most common causes of pleural exudates are bacterial pneumonia and malignancy.

Most common causes of pleural transudates are left ventricular failure and cirrhosis.

Total Protein



Plain universal

TP <25g/L indicates transudate.

TP >35g/L indicates exudate.


Light’s criteria applies to pleural fluid TP between 25 and 35g/L.

A fluid is an exudate if any of the following apply:

Ratio of fluid protein to serum protein is >0.5

Ratio of fluid LDH to serum LDH is >0.6

Pleural fluid LDH is > 2/3rds the upper reference limit for plasma LDH.


Measure serum protein and LDH simultaneously

? infected



See comment

This is part of British Thoracic Society’s guidelines for differentiating infective from non-infective pleural effusions, can only be measured on fresh specimen collected anaerobically using a dedicated blood gas analyzer. This analyser can be found on W513 (respiratory).

? chylothorax




Plain universal


? pancreatitis


Plain universal

Patient's serum amylase should be measured for comparison.

? rheumatic cause


Fluoride oxalate (grey top) tube required.


Nasal Fluid


Tau protein

Plain universal

Sent to Immunology, Sheffield.

Salivary Cortisol



Salivary Cortisol

Salivette or Plain universal

Saliva specimens should be collected using a Sarstedt cortisol salivette (these can be requested from Chromatography). Saliva collected into a plain container by passive drool is also acceptable. 

Synovial Fluid

Refer to Microbiology




Urine pH

?cause of metabolic acidosis


Plain universal

In patients with a metabolic acidosis and suspected renal tubular acidosis, urine pH measurement is indicated.


  • Last updated on .
  • Hits: 2259

General Information

General information about the website and its content

Location of Laboratories

Where the laboratories are located and information about the services offered at each laboratory