It is well known that diabetes is under-diagnosed. Approximately one-third of the individuals with diabetes do not know they have it and it generally takes about 7 years to determine the diagnosis. By that time, irreparable damage may already have occurred. This report offers a reconsideration of the diagnostic criteria for diabetes.
The recommendations and conclusions were drawn by a panel of experts after an extensive literature review was conducted. The review centered on the advantages of using HbA1c as a diagnostic indicator. The screening and diagnosis conclusions were as follows:
1)Screening standards should be established that prompt further testing and closer follow-up of those individuals who have a fasting plasma glucose > to 100 mg/dl, random glucose > 130 mg/dl or have a HbA1c >6%; 2) HbA1c > 6.5-6.9%, confirmed by a plasma glucose specific test such as a fasting plasma glucose or oral glucose tolerance test, should establish the diagnosis of diabetes; 3) HbA1c > 7% and confirmed by another HbA1c or a plasma specific test such as a fasting test or an oral glucose tolerance test should establish the diagnosis of diabetes.
These recommendations were recently published in the July issue of the Journal of Clinical Endocrinology and Metabolism for the review and consideration of clinicians, the clinical community and interested associations and societies. These guidelines place more reliance on the use of HbA1c, which has several advantages over the fasting plasma glucose test. It offers a longer-term picture of glycemia control, does not require the patient to be fasting, is well-standardized and can always be confirmed by a plasma glucose specific test.
About the author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.