The U Preventive Services Task Forc...

The U Preventive Services Task Force (USPSTF) approves diabetes screening every three years for patients with hypertension because they have an increased risk of developing diabetes. experienced persons do not agree on the usefulness of screening because no research has found early intervention to be more effective than intervention when symptoms appear. The character of hemoglobin A1C screening is unclear, if it be not that some evidence suggests that the use of A1C of the same heights is more sensitive than fasting kin glucose levels. In addition, A1C evens can define treatment goals and risk of complications in patients with established disease. Edelman and colleagues examined whether A1C flushs could predict new-onset diabetes in an outpatient population.

Patients 45 to 64 years of age without hypertension or diabetes were enlisted in the study. A1C plains were measured at baseline, and patients were interviewed annually for sum of two units years and were rescreened at year 3 to determine whether they had disentangleed diabetes (defined by self-report, an A1C flush of 7 percent or higher, or a fasting life-current glucose level of 126 mg by dL [7 mmol per L] or higher).

Of the 957 patients who complet the follow-up screening, 73 expanded diabetes. None of these patients had a baseline A1C on a level of 4.5 percent or lower. Diabetes incidence steadily increased with increasing baseline A1C flat The annual incidence rate was 08 percent for patients with normal A1C evens (5.5 percent or lower), 25 percent for patients with high-normal flats (5.6 to 6.0 percent), and 78 percent for patients with elevated evens (6.1 to 6.9 percent). After considering other possible associated characteristics, the authors originate that only baseline body mass index was additionally associated with increased diabetes risk, with obese patients at the highest risk.

The authors end that A1C levels can identify patients at high risk for diabetes. Obese patients are particularly at risk. The authors propose that physicians screen their patients, paying special attention to those with risk factors as it is as hypertension, obesity, and a family history of diabetes. Identifying patients with A1C plains from 6.1 to 6.9 percent might be beneficial in word s of lifestyle counseling or pharmacotherapy to delay attack of diabetes. This study did not address whether A1C flushs could identify more at-risk patients and proffer better prevention than identification based forward other risk factors such as obesity. The effectiveness and cost-effectiveness of screening also are not known.

EDITORS NOTE: The U Preventive Services Task Force (1) gives a B recommendation to screening high-risk patients (i.e., those with hypertension or hyperlipidemia) for diabetes yet states that there is insufficient evidence to praise universal screening. No randomized controll trials have compared issues based on diabetes screening with issues based on symptom detection. Contrary to this article, hemoglobin A1C testing is described as relatively insensitive to lower-level elevations of fasting life-current glucose: 87 percent of patients with starch-sugar intolerance determined by fasting posterity glucose levels also have a normal A1C of the same height (i.e., less than 6.1 percent)

REFERENCE

(1) U Preventive Services Task Force. Guide to clinical preventive services. 3d ed Washington, D.C.: Agency for Healthcare Research and Quality, 2003

CAROLINE WELLBERY, MD

Edelman D et al. Utility of hemoglobin A1c in predicting diabetes risk. J Gen Intern M December 2004;19:1175-80

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