HbA1c: An effective screening tool for cystic fibrosisrelated diabetes?
| Autor: | Christian Benden, Christoph Schmid, Marie-Angela Schnyder |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Cystic Fibrosis endocrine system diseases Cystic fibrosis-related diabetes Type 2 diabetes Cystic fibrosis Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Diabetes Mellitus medicine Humans Screening tool 030212 general & internal medicine Glycated Hemoglobin Lung business.industry nutritional and metabolic diseases Gold standard (test) medicine.disease medicine.anatomical_structure 030228 respiratory system Lung disease Pediatrics Perinatology and Child Health business |
| Zdroj: | Journal of Cystic Fibrosis. 15:261-262 |
| ISSN: | 1569-1993 |
| Popis: | We have read with interest the article by Burgess et al. “HbA1c as a screening tool for cystic fibrosis related diabetes” [1]. The authors studied the relationship between glycosylated haemoglobin (HbA1c) and oral glucose tolerance test (oGTT) in a large number of adult (aged ≥16 years) patients with cystic fibrosis (CF) without a pre-existing diagnosis of CF related diabetes (CFRD). Recently, HbA1c has been accepted as a diagnostic criterion for type 1 and type 2 diabetes, if the value reads ≥6.5% (48 mmol/mol) [2]. With such a high cutoff, HbA1c has very poor sensitivity to detect CFRD in a patient previously not known for the disease; the same is also true for fasting plasma glucose (FPG) if a cutoff of ≥7 mmol/l is used. By contrast, a 2 h plasma glucose value (2hPG) ≥11.1 mmol/l remains an accepted criterion not only for type 1 and type 2 diabetes but also for CFRD, and thus, the oGTT has remained the gold standard for diagnosis of diabetes mellitus. Burgess et al. propose to use HbA1c as a screening tool in patients with CF, with a much lower cutoff, and to perform an oGTT only if the HbA1c is ≥5.8% (40 mmol/mol); an HbA1c b5.8% would predict a negative oGTT, and therefore render an oGTT unnecessary. To reach a high sensitivity (93.8%), a low specificity (53%) would be accepted, and the use of the less patient-friendly oGTT could be reduced to half. Working at the Swiss Adult CF and Lung Transplant Centre in Zurich, we routinely screen our CF patients for CFRD by oGTT unless the diagnosis is already known (from previous testing or treatment; an oGTT was not performed in patients known for previous FPG ≥7.0 mmol/l). We thereby focus our attention particularly on patients with advanced lung disease and lung transplant assessment. Based on our clinical |
| Databáze: | OpenAIRE |
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