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Diagnosis and Treatment |

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
[+] Article, Author, and Disclosure Information

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.

Requests for Reprints: Daniel E. Singer, MD, General Medicine Unit, Bulfinch 1, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.

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 PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(2):125-137. doi:10.7326/0003-4819-110-2-125
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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.





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