HbA1c May be Superior to FPG in Diagnosing Prediabetes

FPG (fasting plasma glucose), HbA1c, and the OGTT (oral glucose tolerance test) are used in determining if someone has prediabetes or diabetes. Indeed, all three measures are employed by the National Diabetes Prevention Program (National DPP) to determine eligibility for the National DPP. So, these blood based tests are important, and understanding which one of the three measurements is the most valid in assessing prediabetes and diabetes is a worthwhile undertaking. One recent study has focused on determining the validity of the measurements.

The OGTT is considered by some to be the gold standard for diagnosing diabetes and prediabetes. However, it is not always practical to perform the test, and results are not always reproducible. Therefore, while the OGTT is considered to be more accurate for some high risk patients than the HbA1c test, the HbA1c test is widely used since it is more practical and it is considered to be a valid test. So, determining how the test stacks up against the FPG test is high on the priority list.

In the above mentioned study, 201 patients were looked at. And the investigators concluded that “HbA1c is a more sensitive test compared to FPG in the diagnosis of DM. Prospective studies with broad participation at national and international levels are needed to redefine HbA1c cut-off points for the diagnosis of DM and prediabetes." When this is done, "it will be possible to revise the diagnostic guidelines accordingly.”

While work needs to be done in the area of defining the cut-off points for HbA1c to improve the diagnostic value of the measurement, the above study does seem to indicate that engaging in additional research to define the Hba1c cut-off points is worth the effort.

Healthcare providers should pay attention to this study and other studies related to diabetes and prediabetes measurements. If we can increase the validity of the measurements already in place, this will lead to improved assessment of prediabetes and diabetes. This endeavor will help providers deliver more accurate assessments to patients, enabling patients to take the appropriate actions.

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