Papoz L, Favier F, Sanchez A, Clabe A, Caillens H, Boyer MC, Schwager JC.
INSERM U500, 39 av Charles Flahault, 34093 Montpellier Cedex 5, France.
The measurement of glycated haemoglobin (HbA(1c)) is a practical and
more sensitive tool than fasting plasma glucose (FPG) in screening type
2 diabetes in current practice. Its use has been limited so far by the
variability of the analytical methods. The standardization process is
going on, and many laboratories are currently using valid methods. Our
study is consistent with the results of other groups who recommended
this measurement to identify undiagnosed diabetic patients, that are
about 25% to 30% in the French population. The demonstration was provided
through a survey including a screening step by both HbA(1c) and G0, and
a second exam with a 2 hr OGTT in a sample of positive screenees according
to at least one criterion (HbA(1c) >=6% or G0 >=1.26 g/L), as well
as in a sample of negative screenees. We showed that nine confirmed diabetic
subjects out of ten had HbA(1c) >=6% at the screening step, while
only a half had G0 >=1.26 g/L. Conversely, 22% of the positive screenees
according to HbA(1c) were not confirmed as diabetic by the OGTT, including
however more than half with abnormal glucose values. A chart for practical
use is proposed to define patients at risk, the process of screening,
and the patient follow-up according to the results of the tests.