More evidence of the problems of using HbA1c for diagnosing diabetes? : the known knowns, the known unknowns and the unknown unknowns

D. Church, D. Simmons

    Research output: Contribution to journalArticlepeer-review

    15 Citations (Scopus)

    Abstract

    For many years, clinicians have sought to be able to diagnose diabetes mellitus using a simple test that can be taken at any time, without fasting, but with comparable, or even better, ability than the oral glucose tolerance test (OGTT) to predict future risk of both micro- and macrovascular disease. After much debate, the WHO advised in 2011 that HbA1c can be used as a diagnostic test for diabetes. More recently, the UK Department of Health Advisory Committee on Diabetes has published an Expert Position Statement for the use of HbA1c for the diagnosis of diabetes in the UK, which provides guidance on its use in practice. In this issue of The Journal of Internal Medicine, Engstrom et al. present population data demonstrating a positive association between RDW and HbA1c by quartiles. The authors propose that low RDW could be a surrogate marker of red cell survival. That those with the lowest RDW have a lower HbA1c yet higher glucose may support this idea, as HbA1c is known to be an excellent marker of red cell turnover. This is a reminder to clinicians that HbA1c is more than a marker of glycaemia when using it for the diagnosis and follow-up of diabetes. The question remains how to identify those whose HbA1c is not an appropriate test to detect diabetes.
    Original languageEnglish
    Pages (from-to)171-173
    Number of pages3
    JournalJournal of Internal Medicine
    Volume276
    Issue number2
    DOIs
    Publication statusPublished - 2014

    Keywords

    • blood sugar
    • diabetes
    • diagnosis
    • erythrocytes
    • hemoglobin

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