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Tests of Glycemia in Diabetes Mellitus
Their Use in Establishing a Diagnosis and in Treatment
- Daniel E. Singer, MD;
- Christopher M. Coley, MD;
- Jeffrey H. Samet, MD; and
- David M. Nathan, MD
Abstract
Purpose: To assess t gluysician-based and self blood glucose monitoring, and assays of glycated hemoglobin in diagnosing and treating diabetes mellitus.
Data Identification: Relevant literature in English from 1957 through early 1988 was identified via textbooks, original research articles, and review and policy papers, supplemented by a computer-based search of the National Library of Medicine MEDLINE database.
Study Selection: Articles were selected because of prominence, based on frequent citation or policy authoritativeness, and relevance to the epidemiologic and clinical constructs of this paper.
Results: We analyze the epidemiologic studies underlying the higher diagnostic glycemic thresholds for diabetes proposed by the National Diabetes Data Group and we suggest a diagnostic strategy in which glycated hemoglobin may substitute for glucose tolerance testing. Our section on treatment stresses matching the intensiveness of hypoglycemic therapy with the intensiveness of monitoring; emphasizing the role of self blood glucose monitoring. Our findings and recommendations are summarized in the figures and tables.
Conclusions: Major advances in the diagnosis and management of diabetes have been made in the past 10 years. In particular, an array of epidemiologic studies have provided a logical basis for diagnostic standards, and two new means of assessing glycemia—glycated hemoglobin and self-monitoring of blood glucose—have become widely available. These tests allow more convenient approaches to diagnosis, and provide a fuller description of glycemia, permitting more informed and intensive therapy.
Article and Author Information
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From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. For current author addresses, see end of text.
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Grant Support: Supported in part by the Blue Cross and Blue Shield Medical Necessity Program. Dr. Singer was supported as a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.
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Requests for Reprints: Daniel E. Singer, MD, General Medicine Unit, Bulfinch 1, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.
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Current Author Addresses: Drs. Singer, Coley, and Samet: General Medicine Unit, Bulfinch 1, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.
Dr. Nathan: Diabetes Unit, Bulfinch 4, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.
- ©1989 American College of Physicians
