Jansen H, Kerssen A, Stolk RP, Rutten GEHM, Nijpels G. HbA1c as diagnostic test for diabetes: an improvement? Huisarts Wet 2013;56(10):506-8.
The American Diabetes Association (ADA) has recently recommended an HbA1C level of 48 mmol/mol or more (HbA1C ≥ 6.5%) as main diagnostic criterion for diabetes mellitus. In this article, we describe the limitations of using HbA1C as diagnostic test for diabetes mellitus. In the first place, a number of other factors, besides the magnitude of glycaemia, influence the level of HbA1C. In addition, the HbA1C level is linearly associated with the risk of macrovascular complications, also with levels < 48 mmol/mol. Use of HbA1C as diagnostic criterion instead of the fasting glucose level or the oral glucose tolerance test will lead to fewer and different patients being diagnosed with diabetes mellitus. In our opinion, the practical advantages of using HbA1C, such as no need for fasting state testing and the smaller influence of factors (such as stress) on measurements, do not outweigh the disadvantages. Overall, we take a different view from that of the ADA regarding the advantages and disadvantages of measuring HbA1C and advise Dutch general practitioners not to change their current practice in this respect.