|
Item
#6
HbA1c
Detects Diabetes
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."
Diabetes
Care. 2003;26:1064-1068
===========================
DID
YOU KNOW:
Hypertensive patients not conventionally deemed dyslipidemic
(normal to mildly elevated cholesterol) who take atorvastatin had 36%
fewer fatal coronary events and nonfatal MI than patients treated with
placebo. Click
Here
[an error occurred while processing this directive]
|
