Mayer B. Davidson, MD
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Davidson MB. Tests of Glycemia. Ann Intern Med. 2003;138:517. doi: 10.7326/0003-4819-138-6-200303180-00020
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Published: Ann Intern Med. 2003;138(6):517.
TO THE EDITOR:
I agree with most of the recommendations made by Barr and colleagues in their article on tests of glycemia for diagnosis of diabetes mellitus (1), having espoused many of them previously (2-5). I would like to make two points, however. First, Barr and colleagues misinterpret the data in their Figure 2. The graph relates the prevalence of retinopathy to glycemic indices broken down into deciles. Each point represents the average prevalence of retinopathy in the decile but the lowest glycemic value of that decile. Barr and colleagues state that the proportion of persons with retinopathy begins to increase at glycemic values that are actually well within the normal ranges. Although the individual values of patients with retinopathy in the initial decile of increased prevalence are unknown, it seems extremely unlikely that most of them congregated at the lower end of the decile. It is much more likely that mean values in the initial decile of increased retinopathy more accurately reflect the glycemic status of persons with retinopathy. These mean values are fasting plasma glucose concentrations of 8.5 to 9.3 mmol/L (154 to 167 mg/dL), 2-hour postchallenge glucose concentrations of 14.2 to 16.5 mmol/L (256 to 298 mg/dL), and hemoglobin A1c levels of 6.7% to 7.5% (3).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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