Implications of Using Hemoglobin A1C for Diagnosing Diabetes Mellitus - 19/08/11
, John P. Mordes, MD b
Correspondence should be addressed to Samir Malkani, MD, Division of Diabetes, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01605Abstract |
Until 2010, the diagnosis of diabetes mellitus was based solely on glucose concentration, but the American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. A1C ≥6.5% identifies fewer individuals as having diabetes than glucose-based criteria. Convenience of A1C test might increase the number of patients diagnosed, but this is unproven. Diagnostic cut-points for both glucose and A1C are based on consensus judgments regarding optimal sensitivity and specificity for the complications of hyperglycemia. A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives.
Le texte complet de cet article est disponible en PDF.Keywords : American Diabetes Association, Diabetes complications, Diabetes mellitus, Diagnosis, Fasting plasma glucose, Glycohemoglobin, Hemoglobin A1C, Oral glucose tolerance test
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| Funding: Supported in part by Center Grant DK32520 from the National Institutes of Health and by grant 7-08-RA-106 from the American Diabetes Association (Dr. Mordes). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. |
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| Conflict of Interest: All authors declare that there are no conflicts of interest. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 124 - N° 5
P. 395-401 - mai 2011 Retour au numéro
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