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Tests of Glycemia
R Graham Barr, MD, DrPH;
James B. Meigs, MD, MPH; and
Daniel E. Singer, MD
18 March 2003 | Volume 138 Issue 6 | Page 517
IN RESPONSE:
We appreciate Dr. Davidson's clarification of Figure 2 in our article; the values of glycemia in the abscissa were minimum values for each decline. Nonetheless, we believe a threshold at which complications begin to occur can refer to the minimum, rather than the mean, of a decile. Fair-minded observers could disagree about the exact thresholds observed in the graphs, but increasing these by one decile only raises thresholds into the lowest "diabetic" range of glycemia (fasting plasma glucose level, 6.0 to 7.5 mmol/L [108 to 136 mg/dL], 2-hour postchallenge plasma glucose level, 8.6 to 13.5 mmol/L [155 to 244 mg/dL], and hemoglobin A1c level, 6.2% to 6.9%). Use of deciles, whether minimums, means, medians, or maximums, introduces arbitrary thresholds. Alternative nonlinear techniques, such as nonparametric splines or smoothing functions, might make identification of thresholds more precise, although the nonstatistical concerns about optimal thresholds for the diagnosis of diabetes remain.
In terms of the preferred tests of glycemia for the diagnosis of diabetes mellitus, we very much agree with Dr. Davidson's recommendation that hemoglobin A1c level should be used (1), particularly in combination with fasting plasma glucose. We stated this opinion in our paper (in Table 2 and in the accompanying text).
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Author and Article Information
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Columbia–Presbyterian Medical Center; New York, NY 10032 (Barr)
Massachusetts General Hospital; Boston, MA 02114 (Meigs, Singer)
1. Davidson MB, Schriger DL, Peters AL, Lorber B. Relationship between fasting plasma glucose and glycosylated hemoglobin: potential for false-positive diagnoses of type 2 diabetes using new diagnostic criteria JAMA. 1999;281:1203-10. [PMID: 10199430].[Abstract/Free Full Text]
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Related articles in Annals:
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Academia and Clinic
Tests of Glycemia for the Diagnosis of Type 2 Diabetes Mellitus
R Graham Barr, David M. Nathan, James B. Meigs, AND Daniel E. Singer
- Annals 2002 137: 263-272.
[ABSTRACT][Full Text]
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