Tests of glycemia in diabetes mellitus. Their use in establishing a diagnosis and in treatment

Ann Intern Med. 1989 Jan 15;110(2):125-37. doi: 10.7326/0003-4819-110-2-125.

Abstract

Purpose: To assess the usefulness of urine glucose testing, physician-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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Blood Glucose / analysis*
  • Blood Glucose Self-Monitoring
  • Diabetes Mellitus / blood*
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / therapy
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / analysis
  • Glycosuria / urine
  • Humans

Substances

  • Blood Glucose
  • Glycated Hemoglobin A