The DOI matches its Crossref record; 71 of the 77 references it cites were found in a registry or an index.
A New Look at Screening and Diagnosing Diabetes Mellitus
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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“As many as one quarter of newly diagnosed diabetic patients already have established diabetic retinopathy and/or nephropathy [4,5,6].”
From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [4]
In the citing paper
“The optimal cutoff values for HbA1c has been intensively reported in previous studies and discussed in several review papers [4,14,15,38,41,42,43,44,45].”
From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [4]
In the citing paper
“In contrast, the International Expert Committee and the ADA have recommended that HbA 1c can be used for screening for diabetes (20,21,24) (see section on HbA 1c In the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing.”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [24]
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6 of the 77 references couldn’t be matched to a known paper.
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Standards of medical care in diabetes 2010
American Diabetes Association (2010) · Diabetes Care · doi:10.2337/dc10-s011 · Cited by 3,470
Standards of medical care in diabetes—2011
American Diabetes Association (2011) · Diabetes Care · doi:10.2337/dc11-s011 · Cited by 2,880
Standards of Medical Care in Diabetes—2012
(2012) · Diabetes Care · doi:10.2337/dc12-s011 · Cited by 2,240
Metadata
- 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.
- 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
- 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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