Best test for detecting diabetes

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A national panel of diabetes experts, pathologists, and internists are promoting hemoglobin A1c (HbA1c) testing as a front-line diagnostic tool for diabetes, particularly for those who are at high risk for the disease. Investigators published a consensus statement supporting their case in July (J Clin Endocrinol Metab. 2008;93:2447-2453).

The group contends that HbA1c —already the gold standard for monitoring established diabetes—is a better diagnostic tool than the at-the-moment glucose testing now in place and could help identify more of the estimated 6 million undiagnosed cases of diabetes in this country.

Whereas current testing methods can be rendered inaccurate by a person's recent diet and exercise regimen, HbA1c values reveal average blood glucose levels over the past 120 days.

According to the panel, individuals with an HbA1c reading ³6% should be tracked with additional glucose or HbA1c tests. Those with a confirmed HbA1c reading >6.5% should be considered to have diabetes.

In related developments:
• The U.S. Preventive Services Task Force (USPSTF) has issued an updated recommendation urging clinicians to screen for type 2 diabetes in asympto-matic adults with sustained BP (either treated or untreated) >135/80 mm Hg (Ann Intern Med. 2008;846-854).

• A group led by David M. Nathan, MD, has cracked the mathematical code that translates HbA1c values from percentages to milligrams per deciliter, the units used in self-monitoring of blood glucose. The new reading—eAG, for estimated average glucose—will allow clinicians and patients to discuss glucose goals using the same language (Diabetes Care. 2008;31:1473-1478).
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