- FRIDAY, May 30 (HealthDay News) — Better screening and diagnosis
for diabetes is being called for to help the 6.2 million Americans who
don't realize they have the disease, a new report says.

“Approximately 30 percent of people with diabetes in the United States
are undiagnosed,” study author Dr. Christopher Saudek, of Johns Hopkins
School of Medicine in Baltimore, said in a prepared statement. “There are
serious deficiencies in the current criteria for diagnosing diabetes, and
these shortcomings are contributing to avoidable morbidity and
mortality.”

A panel of experts examined the current criteria for screening and
diagnosing the disease, making recommendations in a new report to be
published in The Journal of Clinical Endocrinology &
Metabolism.

Many diabetics go undiagnosed, because the most common diagnostic tests
require the patient fast, Saudek said. People who have eaten on the day of
a doctor visit most likely will not be diagnosed unless they have quite
advanced diabetes.

Instead, the panel suggests incorporating different measurement of
glucose, hemoglobin A1c (HbA1c), into the criteria.

Hemoglobin is the oxygen-carrying protein located in red blood cells.
HbA1c is a form of hemoglobin that reflects the average blood glucose
level over the previous several months. It has been used for a long time
to indicate blood sugar levels in patients with diabetes but never as a
screening or diagnostic tool.

Although use of HbA1c was rejected as a tool a decade ago by the
American Diabetes Association, the panel said that most recent evidence of
its strength means it is time to revisit adopting its use.

HbA1c measurement does not require fasting; current accepted tests call
for fasting for at least eight hours. HbA1c more accurately reflects
longer-term glucose concentration in the blood, while short-term lifestyle
changes, such as a few days of dieting or exercise, can influence other
tests. Also, HbA1c laboratory methods are now standardized and
reliable.

The panel recommends that HbA1c levels greater than 6 percent would
require patient follow-up; HbA1c greater than or equal to 6.5 percent
confirmed by a glucose-dependent test would establish the diagnosis of
diabetes.

More information

The American Diabetes Foundation has more about diabetes.