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New uses
for old-line Diabetes Monitoring Test:
Screening and Diagnosis
Newswise — A blood test
currently used as the gold standard for
monitoring people already under care for
diabetes may have far wider use in
identifying millions with undetected
diabetes, a team led by a Johns Hopkins
physician suggests.
The hemoglobin A1c test
(HbA1c), based on a blood sample, is widely
used to keep tabs on how well confirmed
diabetics keep their blood sugar, or
glucose, in check by showing how much
glucose red blood cells have been exposed to
for the past 120 days, the average lifespan
of these cells.
"The test is a measure of
long-term glucose control, but doctors don't
typically use it to screen for or diagnose
the disease, " says Christopher Saudek,
M.D., professor of endocrinology and
metabolism at the Johns Hopkins University
School of Medicine and director of the Johns
Hopkins Comprehensive Diabetes Center.
"There's reason to believe it
could help identify many of the estimated
six million people in the U.S. who have
diabetes but don't know it," he adds.
The current screening and
diagnostic tests measure only the amount of
sugar present at the moment that blood
sample is taken.
Consequently, Saudek says,
these tests are accurate only if patients
fast for at least 10 hours before the test
because glucose concentrations can vary
greatly depending on a person's recent
meals.
Even then, explains Saudek,
the tests miss a significant portion of
people who have diabetes or are at high risk
to develop the disease since glucose also
varies depending on a person's diet and
exercise regimen for several days leading up
to the blood draw.
"If a patient is scheduled
for a physical, he or she may 'tune up' by
changing their regimen for a few days and
throw off their test results, causing
doctors to miss the patient's usual pattern
of high blood sugar," he says.
In a consensus statement
published in the July Journal of Clinical
Endocrinology and Metabolism, Saudek and his
colleagues conclude that the HbA1c test
should be used as a front-line method for
identifying patients with diabetes,
especially for those at high risk for the
disease.
Since the test does not
require fasting and isn't affected by
short-term changes in diet and exercise, the
HbA1c test has significant advantages to
current testing methods.
The consensus was reached by
a group of diabetologists, pathologists and
internists seeking to improve detection
methods because of the serious consequences
of untreated diabetes for patients and
public health.
They met recently in Chicago
with financial support from Metrika Inc., a
major manufacturer of diabetes testing
equipment. The panel deliberations and
manuscript preparation were made
independently of the sponsor, according to
its members.
After reviewing relevant
published studies and available tests, the
national panel recommended that individuals
who score at least 6 percent on an HbA1c
test may have or be at risk for diabetes and
should be tracked with additional glucose or
HbA1c tests.
Those who score between 6.5
percent or above, if confirmed, should be
considered to have diabetes.
"This is a first step towards
changing medical practice," notes Saudek,
and "could greatly enhance how well we're
able to identify people with diabetes."
Others who contributed to the
consensus statement include William H.
Herman of the University of Michigan School
of Medicine, David B. Sacks of Brigham &
Women's Hospital and Harvard Medical School,
Richard M. Bergenstal of the International
Diabetes Center, David Edelman of Durham
Veterans Administration Medical Center and
Duke University, and Mayer B. Davidson of
Charles R. Drew University.
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