Evidence Review for "HbA1c as a Diagnostic Test for Diabetes Mellitus"

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ARTICLE: HbA1c as a Diagnostic Test for Diabetes Mellitus –Reviewing the Evidence, Authored by Chris Florkowski.
1 Introduction
Diabetes mellitus is the most prevalent form of diabetes among American populations. It’s sparked by insulin deficiency and the inability of body cells to optimize insulin uptake. Body failure to correctly utilize insulin results to unprecedented increase in blood glucose levels. High levels of glucose have the potential to cause kidneys, heart and other body parts to malfunction. Therefore early diagnosis and management of Type 2 diabetes is critical for purposes of control and intervention. This essay sets out to review an evidence based diagnostic tool used for early diagnosis of Type 2 diabetes. The main focus of the paper will be to summarize the main findings on the use ofHbA1c as a diagnostic tool for diabetes mellitus.
2 Glucose Based Criteria for Diabetes Type 2 Diagnosis
Recent evidence based findings suggest that blood glucose levels can be determined through two methods: in fasting state or after a standard glucose load. However certain populations with high prevalence have depicted a bimodal distribution pattern. Thus the findings of these two evidence based diagnostic methods have informed the basis for the cut-off glucose levels. Recommendations on Type-2 diabetes diagnosis based on fasting and 2 hour plasma glucose has been available since 1979. The cut-off for diagnosis was set at glucose levels ≥7.8 mmol/L in the fasting state(Florkowski, 2013). Alternatively, the diagnosis could be established at glucose levels ≥11.1 mmol/L following a 75 g glucose load. An intermediate range was set; which establisheda post-load glucose range to between7.8 mmol/L and 11.0 mmol/L (Florkowski, 2013). The clinical criteria werelater reviewed leading to adoption of fasting glucose cut-off levels of ≥7.0 mmol/L. The recommended fasting glucose levels were set to range between 6.1 mmol/L and 6.9 mmol/L, even though the previous post load glucose criteria was retained(Florkowski, 2013).
3 Analysis of HbA1c Diabetes Diagnostic Test
The recent evidence based findings suggest thatHbA1c diagnostic test helps determine the existence of chronic glycaemia as opposed to just providing a snapshot test of glycaemia. This diagnostic tool is preferred as it provides integrated criteria over a 120 day period within which glycaemia has over 50% effect on HbA1c(Florkowski, 2013). This makes this tool most ideal for diagnosing diabetes mellitus as it’s characterized by chronic hyperglaecamia. Moreover, HbA1c testing is simple as it eliminates the fasting requirement and utilizes a single blood sample. Thisled to enhanced uptake of testing and diagnosis(Florkowski, 2013).
Unlike other diabetes diagnostic tests that employ glucose tolerance test (OGTT), HbA1c is not impacted by prandial status. Moreover, it does not exhibit diurnal rhythm thereby making it possible to conduct the test at any time of the day. HbA1c depicts very minimal pre-analytical disparity as compared to plasma glucose. The recent evidence also indicates that HbA1c test is stable after collection. Comp...