Various observational studies documented that an increased prevalence of nonproliferative diabetic retinopathy can be observed with fasting glucose levels around 7.0 mmol/L (126 mg/dL) and 2-h PG around 11.1 mmol/L (200 mg/dL). A1C is better associated with chronic complications than FPGĭifferent from National Diabetes Data Group criteria, which were essentially based on distribution of glucose levels within the general population, the 1997 ADA criteria (and the subsequently recommended World Health Organization criteria) established diabetic glycemic levels by means of their association with retinopathy, the most exclusive and specific diabetes complication. Therefore, a diagnostic tool gauging chronic rather than spot hyperglycemia is certainly preferable. From a clinical standpoint, having an FPG of 120 or 130 mg/dL or having a 2-h PG of 185 or 215 is virtually the same, but from the patient’s perspective (perception of having a disease, psychological well-being, health insurance, recognition of particular benefits, or imposition of certain limitations, etc.), it makes a substantial difference. Of note, the 2-h PG had poor reproducibility. This is particularly valid when FPG oscillates above and below the cut point of 126 mg/dL or 2-h plasma glucose (PG) oscillates above and below the cut point of 200 mg/dL. The measurement of A1C equals the assessment of hundreds (virtually thousands) of fasting glucose levels and also captures postprandial glucose peaks therefore, it is a more robust and reliable measurement than FPG and/or 2-h OGTT plasma glucose. Labeling a person with a diagnosis of diabetes has several psychological and legal implications and requires a robust and reliable approach. Accordingly, there are some good examples in medicine: urinary albumin excretion rate provides more reliable information on the presence and the degree of microalbuminuria than spot urinary albumin-to-creatinine ratio serum IGF-I is definitely more efficacious than serum growth hormone when monitoring patients with acromegaly, etc. In this respect, there is no doubt that a biochemical or clinical parameter describing the extent of a biological phenomenon over a long period provides a more robust indicator of glycemia than a parameter describing it in the short term or in a given moment only. In addition, the two assessments required to confirm diagnosis might be fallacious in describing a chronic and complex clinical condition. However, fasting and 2-h OGTT gauge just a moment of a single day. Hyperglycemia as the biochemical hallmark of diabetes is unquestionable. Diabetes has been diagnosed for decades with fasting plasma glucose (FPG) assessment or, much less frequently, with an oral glucose tolerance test (OGTT).
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