HbA1c
is a useful marker for case finding of diabetes patients.
" HbA1c
level is considered an important monitoring tool in treating patients with
diabetes, but it is not currently recommended for screening or for the diagnosis
of diabetes," write Laura S. Greci, MD, MPH, from Yale University School of
Medicine in Derby, Connecticut, and colleagues. "To our knowledge, this is the
first study reporting on the role of HbA1c
level for diabetes case finding in hospitalized patients with hyperglycemia.
This situation may provide a golden opportunity to locate, educate, and begin
treating the large number of undiagnosed patients with diabetes."
From March 20 to July
31, 2000, 508 patients admitted through the emergency department of a single
hospital were tested for random hyperglycemia, defined as plasma glucose greater
than 125 mg/dL.
Of 50 patients (9.8%)
with hyperglycemia but without corticosteroid use or history of diabetes, 35
patients (70%) completed the study, and 21 patients (60%) were diagnosed with
diabetes based on testing of fasting plasma glucose while hospitalized.
Mean HbA1c
levels were higher in subjects with diabetes than in subjects without diabetes
(6.8 ± 0.4 vs. 5.3 ± 0.1%; P = .002). Using a cutoff of greater than
6.0%, the HbA1c
level was 100% specific (14 of 14 patients) and 57% sensitive (12 of 21
patients) for the diagnosis of diabetes. Using a lower cutoff value of HbA1c
at 5.2%, specificity was 50% (10 of 21 patients) and sensitivity was 100% (7 of
14 patients).
"In acutely ill
patients with random hyperglycemia at hospital admission, an HbA1c)
level greater than 6.0% reliably diagnoses diabetes, and an HbA1c
level less than 5.2% reliably excludes it (paralleling the operating
characteristics of the standard fasting glucose measurements)," the authors
write.
Study limitations
include small sample size, older patient population, and possible effect of
acute medical condition on the gold standard of testing fasting plasma glucose
while hospitalized. The authors warn that the clinical algorithm in this study
needs to be validated in prospective studies on different populations.
"Issues of cost, labor, laboratory
use, and patient convenience and compliance will also need to be factored in to
the best approach in hospitalized patients," they write. "This quicker diagnosis
of diabetes with the HbA1c
level can also translate into an early inpatient mobilization of diabetes
support services (e.g., nutrition and education), treatment, and even early
medication response."
Source: Diabetes In Control Dot Com: Diabetes Care. 2003;26:1064-1068.
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