HDCN Article Review/Hyperlink

Peters AL, Davidson MB, Scriger DL, Hasselblad V for the Meta -analysis Research Group

A clinical approach for the diagnosis of diabetes mellitus: An analysis using glycosylated hemoglobin levels

J Am Med Assoc (Oct) 276:1246-1252 1996

Guidelines for diabetes screening are presented by the ADA in the January 1996 supplement of Diabetes Care (see "Practice Guidelines" at the bottom of the home page of HDCN). The mainstay is the fasting plasma glucose level (> 115 mg/dl indicates the need for further testing) or a random plasma glucose level > 160 mg/dl, followed by and oral glucose tolerance test (OGTT).

The paper by Peters and colleagues suggests a different approach. They did a meta-analysis of all papers in which both an OGTT was done and glycosylated hemoglobin levels (HbA1c) were measured, to see if the latter could be used as a substitute test. HbA1c had the least variance in normal subjects. Using a database of about 9000 subjects, they found that when the HBA1c level was greater than 7.0%, 89% patients had diabetes, 7% had impaired glucose tolerance, and 4% were normal. They suggest that patients with HbA1c levels > 7% need pharmacologic intervention (based on no data), whereas persons with levels %lt; 7% may need only tx with diet and exercise (again, based on no data). The approach is superficially attractive, however. It would be interesting to assess the variance of repeated measurement of the OGTT vs. HbA1c (John T. Daugirdas, M.D., University of Illinois at Chicago)

The full abstract is available at the JAMA site. You will need to register with the JAMA before being allowed to access this material. Once you have registered, read the abstract.