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Redefining the Diagnosis of Diabetes Using Glycated Hemoglobin

V. Fonseca,S. Inzucchi,E. Ferrannini

Published 2009 in Diabetes Care

ABSTRACT

The worldwide epidemic of type 2 diabetes continues unabated. Despite extensive efforts to educate providers, patients, and even the public at large as to the advantages of early identification and treatment to prevent complications, a large number of patients remain undiagnosed. A serious barrier to an enhanced detection of diabetes has been inadequate screening using tests somewhat inconvenient to patients and clinicians and therefore often not optimally implemented. In this issue of Diabetes Care , a joint American Diabetes Association, International Diabetes Federation, and European Association for the Study of Diabetes International Expert Committee examines diagnostic testing for diabetes, specifically, the role of A1C, and makes significant new recommendations. While this report has not yet been endorsed as a guideline by either of the associations (or other organizations), it does represent a step in that direction and thus deserves attention. Clearly, no clinical diagnostic test is perfect. However, to be clinically useful, a test must be accurate, specific, standardized (or easily standardizable), handy, and, ideally, inexpensive. While plasma glucose testing meets some of these criteria, its use has been dogged by the need to obtain a sample in the fasting state (most people attend their outpatient visits in the fed state) or under standard carbohydrate challenge conditions, i.e., the oral glucose tolerance test. There also continues to be a degree of uncertainty concerning the diagnostic performance of fasting glucose testing versus that of the oral glucose tolerance test—the latter done rarely in clinical practice for obvious reasons: inconvenience and cost. In addition, considerable variability not only in 2-h postglucose load values but also in fasting glucose has been a problem. Appropriately, clinicians have long wondered why they cannot use another diagnostic index, …

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