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Question
The screening for diabetes is simple, quick, and not expensive, but it is not a diagnosis. I assume that this screening is on the basis of a random plasma glucose test (just a regular fingerstick) — am I right? How valuable do you think screenings like this are? I'm sure that the other accepted diagnostic tests (e.g., a plasma glucose value of 126 mg/dl [7 mm/l] or more after an 8-hour fast or anAnswer
Traditionally, diabetes is diagnosed by elevated blood sugar values. Symptoms are optional, because sometimes people have symptoms mimicking diabetes, but in fact the symptoms are later found to be due to other causes. Urine sugars would be misleading since they might be falsely positive in the rare syndrome of renal glycosuria and falsely negative if someone has a highWhy not use HbA1c? Not because the ADA makes the pronouncement that
The use of the hemoglobin A1c (A1C) for the diagnosis of diabetes is not recommended at this time. (See DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS, and notice they don't give a reference for their statement!)
I think it's simply since no one has done the clinical trials needed to ascertain the utility of the A1c in diagnosing diabetes. Additionally, older A1c methods could be confounded by abnormal hemoglobins, which would give elevated results in A1c assays even in people without diabetes.
I usually ordered both blood glucose and A1c if a patient presented with symptoms of diabetes. If both are elevated, it helps nail the diagnosis, and gives a baseline A1c for later comparison.
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