Pathology
Page highlights
The glycated haemoglobin or haemoglobin A1C (HbA1c) test, as the standard, remains the most utilised Medicare Benefits Schedule (MBS) service for diabetes diagnostic testing and the ongoing management of established diabetes.
In 2020, 542,000 people (2,100 per 100,000 population) screened as asymptomatic though high-risk, accessed an MBS-subsidised HbA1c test to determine a diagnosis of diabetes
Monitoring established diabetes
In 2020, 769,000 people (3,000 per 100,000 population) received a HbA1c check for the management of established diabetes.
Screening for gestational diabetes
In 2020, 163,500 women (2,700 per 100,000 population) received a diagnostic test for gestational diabetes with most (98%) accessing the oral glucose tolerance test and a further 2% accessing the oral glucose challenge test.
According to data from the Australian Diabetes Clinical Quality Registry, in 2024, glycaemic control targets were inadequately met, with the median HbA1c for both type 1 diabetes (7.7%) and type 2 diabetes (8.0%) being above target. Similar proportions of people with type 1 diabetes (31%) and type 2 diabetes (29%) met the target HbA1c of ≤7% (or ≤53 mmol/mol).
Pathology service usage
The Medicare Benefits Schedule (MBS) data collection contains information on services that qualify for a benefit under the Health Insurance Act 1973 and for which a claim has been processed. These data provide insight into the usage of pathology services for diabetes diagnostic testing and the ongoing management of established diabetes, both for which the HbA1c test, as the standard, remains the most utilised MBS service (Figure 1). Note, these data will be updated soon with the latest data.
Figure 1: Number of people who received MBS-subsidised services for diabetes diagnostic testing and/or management of established diabetes, 2014–2020
The chart shows that HbA1c test has been the most utilised service for diabetes management since 2014 and for diagnosis since 2016.
Diagnosing diabetes
In 2020, 542,000 people (2,100 per 100,000 population) screened as asymptomatic though high-risk, received a MBS-subsidised HbA1c test to determine a diagnosis of diabetes. Overall, the number of people accessing this service generally increased with increasing age, peaking among those aged 75–79 (5,420 per 100,000 population). Rates per 100,000 population were slightly higher among females than males overall, largely driven by a spike in numbers among females in the 15–49 age group, possibly due to the use of HbA1c in pregnancy-related diabetes screening.
The introduction of the HbA1c item on the MBS for diagnostic purposes in November 2014 enabled general practitioners (GPs) to detect diabetes in people considered to be high-risk according to elevated HbA1c only rather than the more formal oral glucose tolerance test (OGTT). This shift contributed to an almost 30-fold increase in people accessing diagnostic HbA1c services through the MBS between 2014 and 2020 and a halving in the number of people accessing the MBS-subsidised OGTT (Figure 1).
Monitoring established diabetes
In 2020, 769,000 people (3,000 per 100,000 population) received a HbA1c test for the management of established diabetes. The number of people accessing this item has remained steady since 2014 and, notably through the first waves of the COVID-19 pandemic throughout 2020 and early 2021 (Figure 2). Overall numbers for the HbA1c item to monitor established diabetes were 1.4 times higher among males than females in 2020 and rates increased with increasing age, peaking among both males and females in the 75–79 age group.
While people are eligible to access MBS-subsidised HbA1c tests for the management of established diabetes up to 4 times per year, on average people received this service only 1.5 times per year between 2014 and 2020 with a similar pattern between males and females.
Figure 2: Number of people who received a MBS-subsidised HbA1c test for the management of established diabetes by sex, April 2014 to August 2021
The chart shows the number of people receiving this service fluctuated over this period, ranging from 74,000 to 110,000 per month.
The management of pre-existing diabetes during pregnancy is important for the wellbeing of the mother and baby. In 2020, 15,900 women (262 per 100,000 population) received a HbA1c test for the management of pre-existing diabetes in pregnancy. The number of women accessing this item has increased steadily since 2014 with a spike in April and May 2020 (Figure 3), likely impacted by temporarily revised guidelines for gestational diabetes screening in response to the COVID-19 pandemic – refer to the Impact of COVID-19: Diabetes monitoring for further information. By early 2021, demand for this item had returned to pre-COVID levels.
Screening for gestational diabetes
Screening for gestational diabetes is universally recommended for pregnant women without diabetes already detected in the current pregnancy between 24–28 weeks’ gestation. However, women with a previous history of gestational diabetes or an early pregnancy HbA1c level ≥ 6.0–6.4, but without diagnosed diabetes, are advised to be tested before 20 weeks’ gestation, ideally between 10 and 14 weeks’ gestation (Sweeting et al. 2025). In 2020, around 163,000 women (2,700 per 100,000 population) received a diagnostic test for gestational diabetes with most (98%) accessing the OGTT and a further 2% accessing the oral glucose challenge test (OGCT).
Gestational diabetes screening rates remained steady between 2014 and 2019, followed by an 11% drop in 2020 (down from 184,000 to 163,000 tests). Numbers in 2020 were likely impacted by temporarily revised guidelines for gestational diabetes screening in response to the COVID-19 pandemic – refer to the Impact of COVID-19: Diabetes monitoring for further information. The number of women accessing these MBS subsidised services (processed to 1 August 2021), indicate the use of the OGTT and OGCT had returned to pre-COVID levels (Figure 3).
The use of MBS data and birth records data provide a proxy measure for the proportion of pregnant women being tested for gestational diabetes. Based on the number of women accessing the OGTT and/or OGCT, this proportion has increased steadily in recent years from 55% in 2014 to 62% in 2019. Note these figures likely underestimate the total proportion of pregnant women tested for gestational diabetes as women consistently represent around 60% of all people who receive a HbA1c test for the diagnosis of diabetes among the 15–49 age group – an indication that HbA1c may also be used for gestational diabetes screening.
Figure 3: Number of women who received MBS-subsidised services for the diagnosis of gestational diabetes and management of pre-existing diabetes in pregnancy, by month, January 2014 to August 2021
The number of women receiving the OGTT was steady till 2019, dropped to its lowest in May 2020 and had risen to pre-COVID levels by 2021.
Ongoing monitoring
Monitoring of key biomedical targets aims to reduce and manage diabetes complications. Two key monitoring targets are:
- keep blood glucose levels within a specified target range
- maintain blood pressure within acceptable levels.
Blood glucose monitoring helps health professionals determine the best management strategy for people living with diabetes. Keeping blood glucose levels within a target range can help reduce a person’s risk of developing a range of diabetes-related complications.
Median HbA1c
The Australian Diabetes Clinical Quality Registry (ADCQR), formerly the Australian National Diabetes Audit – Australian Quality Clinical Audit (ANDA – AQCA), was established to improve the quality of care and outcomes for people living with diabetes. It provides annual updates on diabetes practice processes and outcome data for participating diabetes services in Australia (ADCQR 2024). Of the nearly 3,000 people aged 18 and over with diabetes who had an HbA1c measurement recorded in 2024, the median HbA1c was 7.9% (above the ≤7% target). Median HbA1c was 7.7% among people with type 1 diabetes and 8.0% in people with type 2 diabetes. Among people with diabetes who had an HbA1c measurement recorded, 30% had the target HbA1c of ≤7%, the optimum goal for the management of diabetes, with 31% and 29% of those with type 1 and type 2 diabetes meeting the target HbA1c, respectively.
Diabetes with an HbA1c result
The Practice Incentives Program (PIP) Quality Improvement Measures (QI) Quality Improvement Measure 1 (QIM 1) reports on the proportion of regular clients with a recorded diagnosis of type 1, type 2 or undefined diabetes and who had a HbA1c result in their GP record from the previous 12 months. Regular clients are defined as individuals who had visited a practice 3 or more times in the 2 years prior to the date of the data extraction and whose service events were eligible for an MBS rebate. Data are collected from over 5,700 general practices across 31 Primary Health Networks in Australia (AIHW 2025).
As of July 2025, 57% of regular clients with a record of type 1 diabetes had an HbA1c result recorded in their GP record in the previous 12 months. This proportion was higher in regular clients with a record of type 2 diabetes (72%) and undefined diabetes (66%). The proportion of regular clients with an HbA1c result in the previous 12 months increased with increasing age and was highest in the 65 and over age group for type 1, type 2 and undefined diabetes. Of note, HbA1c results recorded elsewhere, for example in specialist settings where the clinical information system (CIS) of the client’s usual general practice is not compatible with the specialist service, are not captured in the report.
Diabetes with blood pressure recorded
The PIP QI Quality Improvement Measure 10 (QIM 10) provides information on the proportion of regular clients with a diagnosis of diabetes (type 1, type 2 or undefined) and a recorded blood pressure in their GP record in the previous 6 months (AIHW 2025).
As of July 2025, 58% of regular clients with diabetes had blood pressure recorded in their GP record in the previous 6 months. This proportion increased with age and was highest in the 65 and over age group (64% in both males and females) and lowest in the 0–14 age group (8% in males and 10% in females).
Between July 2024 and July 2025, the proportion of regular clients with diabetes who had blood pressure recorded in their GP record within the previous 6 months remained constant at 57.8% and 58.4%, respectively. Of note, blood pressure recorded elsewhere for example specialist services might not be captured in this report.
Data from the Australian Diabetes Clinical Quality Registry show that of the people with diabetes who had blood pressure recorded, 34% achieved a blood pressure of <130/80 mmHg and 65% achieved a blood pressure <140/90 mmHg (ADCQR 2024).
Glycated haemoglobin, haemoglobin A1c or HbA1c, is the main biomarker used to assess long-term glucose control in people living with diabetes. Haemoglobin is a protein in red blood cells which can bind with sugar to form HbA1c. It is directly related to blood glucose levels and strongly related with the development of long-term diabetes complications. Because red blood cells can live for up to 120 days, HbA1c gives an indication of blood glucose over a few months.
- The HbA1c test was endorsed for the diagnosis of diabetes in 2010 by the Australian Medical Association. Diagnosis is confirmed using HbA1c levels ≥48 mmol/L or ≥6.5%. HbA1c targets for people living with diabetes depend on the type of diabetes, life expectancy, risk of hypoglycaemia and other comorbidities. Regular monitoring for HbA1c forms an important part of diabetes management and preventing long-term complications (Wang and Hng 2021).
- The oral glucose tolerance test (OGTT) assesses venous plasma (blood) glucose before and 2 hours after a 75g oral glucose load. The OGTT is considered the gold standard for the diagnosis of gestational diabetes but can also be used in the general population. A diagnosis of gestational diabetes is confirmed using blood glucose level – fasting (≥5.3–6.9 mmol/L); after 1 hour (≥10.6 mmol/L); after 2 hours (≥9.0–11.0 mmol/L). A diagnosis of diabetes in the non-pregnant population is confirmed using blood glucose level – fasting (≥7.0 mmol/L); after 2 hours (≥11.1 mmol/L) (RCPA 2024).
- The oral glucose challenge test (OGCT) is a shorter version of the OGTT with (non-fasting) blood glucose measured 1 hour after a 50g or 75g oral glucose load. A level of 7.8 mmol/L for 50g (or ≥8.0 mmol/L for 75g) is the suggested cut-off for a diabetes diagnosis. Patients exceeding these cut-offs are recommended to undergo an OGTT.
- Although not included in the analysis for this report, the Medicare Benefits Schedule (MBS) provides rebates for a range of additional services for the management of established diabetes including the quantitation of fructosamine, quantitation of urinary albumin/creatine ratio in urine, measurement of total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol and assessment for microalbuminuria (RACGP 2020).
- From November 2021, greater emphasis has also been placed on the role of primary care in the management of established diabetes, with the introduction of routine HbA1c point-of-care services on the MBS (Department of Health 2021).
AIHW (Australian Institute of Health and Welfare) (2025) Practice Incentives Program Quality Improvement Measures: annual data update 2024–25, AIHW, Australian Government, accessed 24 February 2026.
ADCQR (Australian Diabetes Clinical Quality Registry) (2024), Australian Diabetes Clinical Quality Registry Annual Report (2024), Monash University, School of Public Health and Preventive Medicine, accessed 02 February 2026.
Department of Health (2021) Point-of-care HbA1c testing for patients with diagnosed diabetes, MBS Online website, accessed 21 March 2022.
Nankervis A, Mclntyre H, Moses R, Ross G, Callaway L, Porter C, Jeffries W, Boorman C, De Vries B and McElduff A, for the Australasian Diabetes in Pregnancy Society (2014) ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia, Sydney: Australasian Diabetes in Pregnancy Society.
RACGP (The Royal Australian College of General Practitioners) (2020) Management of type 2 diabetes: A handbook for general practice, RACGP website, accessed 8 March 2022.
RCPA (The Royal College of Pathologists of Australasia) (2024) Glucose Tolerance Test RCPA website, accessed 21 April 2026.
Sweeting A, Hare MJ, de Jersey SJ, Shub AL, Zinga J, Foged C, Hall RM, Wong T, Simmons D. (2025) 'Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes', Medical Journal of Australia, 4;223(3):161-167, doi:10.5694/mja2.52696.
Wang M and Hng TM (2021) 'HbA1c: More than just a number', Australian Journal of General Practice, 50(9):628-32, doi:10.31128/AJGP-03-21-5866.