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First major departure in 30 years in diabetes diagnosis

"This is the first major departure in 30 years in diabetes diagnosis," committee chairman David M. Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School in Boston, declared in presenting the committee's findings."A1C values vary less than FPG [fasting plasma glucose] values and the assay for A1C has technical advantages compared with the glucose assay," Dr. Nathan said. A1C gives a picture of the average blood glucose level over the preceding 2 to 3 months, he added.

The American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) have joined forces to recommend the use of the hemoglobin A1C assay for the diagnosis of diabetes.

 

"A1C has numerous advantages over plasma glucose measurement," Dr. Nathan continued. "It's a more stable chemical moiety.... It's more convenient. The patient doesn't need to fast, and measuring A1C is more convenient and easier for patients who will no longer be required to perform a fasting or oral glucose tolerance test.... And it is correlated tightly with the risk of developing retinopathy."

A disadvantage is the cost. "It is more expensive," Dr. Nathan acknowledged. However, cost analyses have not been done, "...and costs are not the same as charges”

The committee has determined that an A1C value of 6.5% or greater should be used for the diagnosis of diabetes.

This cut-point, Dr. Nathan said, "is where risk of retinopathy really starts to go up."

He cautioned that there is no hard line between diabetes and normoglycemia, however, "...an A1C level of 6.5% is sufficiently sensitive and specific to identify people who have diabetes."

“A1C is the best test to assess risk of retinopathy."

SOURCE:

American Diabetes Association (ADA) 69th Scientific Sessions. Presented June 5, 2009.

Diabetes Care. Published online June 5, 2009.

 
 
 
 
 
 
 
 
 
 
 
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