BMJ 1994;309:537-538 (20 August)

Letters

Tests for diagnosing diabetes mellitus Glucose tolerance test is most sensitive

EDITOR, - David R McCance and colleagues state that the two hour plasma glucose, glycated haemoglobin, and fasting plasma glucose concentrations are equivalent predictors of the development of retinopathy and nephropathy.1 They therefore consider all three glycaemic variables to be equivalent for diagnosing diabetes. This conclusion should be viewed with caution.

With regard to the sensitivity and specificity of glycaemic variables used, their roles in predicting microangiopathy and diagnosing diabetes need to be clearly distinguished. On the basis of data presented in tables I and II in the authors' paper (table), the oral glucose tolerance test has the highest sensitivity in diagnosing diabetes. 


Number (percentage) of patients with values above cut off points in McCance
and colleagues' study
----------------------------------------------------------------------
                     Two hour            Fasting
                      plasma             plasma          Glycated
                      glucose            glucose        haemoglobin
----------------------------------------------------------------------
                       Prevalence (from table I)

Retinopathy         210 (22.0)         135 (14.1)        135 (14.1)
Nephropathy         211 (22.1)         134 (14.0)        134 (14.0)

                  Five year incidence . . . [Full text of this article]


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Relevant Article

Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes
D R McCane, R L Hanson, M A Charles, L T H Jacobsson, D Dj Pettitt, P H Bennett, and W C Knowler
BMJ 1994 308: 1323-8. [Abstract] [Full Text]

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