Cited by 432Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes and associated disorders

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A New Look at Screening and Diagnosing Diabetes Mellitus

Saudek, Christopher D., Herman, William H., Sacks, David B., Bergenstal, Richard M., Edelman, David, Davidson, Mayer B.·2008·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2007-2174

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Abstract

Objective: Diabetes is underdiagnosed. About one third of people with diabetes do not know they have it, and the average lag between onset and diagnosis is 7 yr. This report reconsiders the criteria for diagnosing diabetes and recommends screening criteria to make case finding easier for clinicians and patients. Participants: R.M.B. invited experts in the area of diagnosis, monitoring, and management of diabetes to form a panel to review the literature and develop consensus regarding the screening and diagnosis of diabetes with particular reference to the use of hemoglobin A1c (HbA1c). Participants met in open session and by E-mail thereafter. Metrika, Inc. sponsored the meeting. Evidence: A literature search was performed using standard search engines. Consensus Process: The panel heard each member’s discussion of the issues, reviewing evidence prior to drafting conclusions. Principal conclusions were agreed on, and then specific cut points were discussed in an iterative consensus process. Conclusions: The main factors in support of using HbA1c as a screening and diagnostic test include: 1) HbA1c does not require patients to be fasting; 2) HbA1c reflects longer-term glycemia than does plasma glucose; 3) HbA1c laboratory methods are now well standardized and reliable; and 4) errors caused by nonglycemic factors affecting HbA1c such as hemoglobinopathies are infrequent and can be minimized by confirming the diagnosis of diabetes with a plasma glucose (PG)-specific test. Specific recommendations include: 1) screening standards should be established that prompt further testing and closer follow-up, including fasting PG of 100 mg/dl or greater, random PG of 130 mg/dl or greater, or HbA1c greater than 6.0%; 2) HbA1c of 6.5–6.9% or greater, confirmed by a PG-specific test (fasting plasma glucose or oral glucose tolerance test), should establish the diagnosis of diabetes; and 3) HbA1c of 7% or greater, confirmed by another HbA1c- or a PG-specific test (fasting plasma glucose or oral glucose tolerance test) should establish the diagnosis of diabetes. The recommendations are offered for consideration of the clinical community and interested associations and societies.

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Authors: Saudek, C. D., Herman, W. H., Sacks, D. B., Bergenstal, R. M., Edelman, D., & Davidson, M. B.
Affiliations: Johns Hopkins University (US)
University of Michigan (US)
Brigham and Women's Hospital (US)
International Diabetes Center (R.M.B.), Minneapolis, Minnesota 55416
Duke University (US)
Charles R. Drew University of Medicine and Science (US)
Corresponding author: Saudek, Christopher D.
ORCID: Herman, William H.
Sacks, David B.
Bergenstal, Richard M.
Edelman, David
Davidson, Mayer B.
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2008-07-01
Volume: 93
Issue: 7
Pages: 2447-2453
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2007-2174
OpenAlex: W2168825241
Cited by: 432
References: 77
Citations by year: 2026: 1 · 2025: 6 · 2024: 6 · 2023: 9 · 2022: 18 · 2021: 13 · 2020: 11 · 2019: 15 · 2018: 15 · 2017: 27 · 2016: 27 · 2015: 28 · 2014: 32 · 2013: 22 · 2012: 44
FWCI: 7.31
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
Funders: American Diabetes Association
Johns Hopkins University
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords: diabetes mellitus, diabetes screening, diabetes diagnosis, HbA1c, diagnostic criteria, fasting blood glucose, oral glucose tolerance test, underdiagnosis, glycemic control, consensus recommendations
MeSH terms: Blood Glucose, Diabetes Mellitus, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Sensitivity and Specificity

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A New Look at Screening and Diagnosing Diabetes Mellitus

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