Doubt over HbA1c use to screen for type-2 diabetes

Using HbA1c alone to screen for type-2 diabetes risks misdiagnosing large numbers of people, a leading biochemist has warned.

People of African, Mediterranean or south-east Asian heritage with diabetes, HbA1c tests can be inaccurate
People of African, Mediterranean or south-east Asian heritage with diabetes, HbA1c tests can be inaccurate

HbA1c-only tests have been proposed by an international expert panel. If the WHO backs this view, the DoH and Diabetes UK will consider it too.

Eric Kilpatrick, consultant in chemical pathology at Hull Royal Infirmary, co-authored a BMJ piece listing concerns with an HbA1c-only system.

In people of African, Mediterranean or south-east Asian heritage with diabetes, HbA1c tests can be inaccurate, the authors said.

‘If HbA1c is the sole means of diagnosis...we cannot identify wrongly diagnosed patients without the additional expense, interpretation, and consent required for concurrent haemoglobinopathy screening,' they said.

Problems also exist with the standardisation of the HbA1c test, they pointed out.

‘These issues, and the potential list of tests required in addition to HbA1c to ensure its accuracy, make the idea of simply fasting overnight for a glucose test much more appealing,' they argued.

 

 

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