Combining fasting plasma glucose and glycosylated hemoglobin improved the accuracy for detecting patients with diabetes: COMMENTARY

Leibovici, Leonard
November 2003
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, p78
Academic Journal
In the study by researchers S.S. Anand and colleagues, the overall sensitivity of fasting plasma glucose (FPG) for diagnosing diabetes was low (48%). In clinical practice, we prefer to know which patients with normal or impaired FPG have diabetes according to the oral glucose tolerance test (OGTT). Patients with cardiovascular risk factors and increased risk for mortality cluster in this group. If they have abnormal glucose metabolism, different follow-up and management may be required. Because of the burden of screening a large population we have no other choice, although in certain populations the FPG levels might miss a small percentage of patients with diabetes. Although the question about screening does not have clear-cut answers, some conclusions may be drawn: First, persons with normal or impaired FPG should be stratified according to their risk for diabetes. Factors to consider include ethnic origin, obesity, and family history. A formal index should be developed and validated for that purpose. Second, persons at high risk for diabetes and cardiovascular morbidity should be closely followed even if FPG is normal. Third, the decision to use OGTT, a combination of FPG values and HbA[sublc], or close follow-up depends on the local population, as well as the cost of the tests. Fourth, serious and continuous effort should be made in these patients to modify risk factors and maintain healthy lifestyles.


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