Very useful article in this week’s New England Journal. We usually screen healthy adults for diabetes by drawing a fasting blood glucose as part of the annual physical. This study from Johns Hopkins suggests that glycated hemoglobin might be a better test.
Particularly impressive is the accuracy with which glycohemoglobin predicts cardiovascular outcomes such as heart attack and stroke in non-diabetics.
Glycohemoglobin is a well-known predictor of vascular events in people with diabetes – but the fact that it is such a powerful predictor of vascular disease and death in non-diabetics is big news.
Many of my patients have slightly high fasting blood sugars on their physical. It’s hard to know what to tell them. Does a blood sugar of 103 mean they are going to get diabetes? Do they need to be on medicine like metformin to lower their sugar?
It looks like glycohemoglobin (which gives an “average” for the blood sugar over a three month period) will be a much more accurate test. We can avoid frightening patients over meaningless random fluctuations in glucose; and we can better identify those in need of real risk factor modification or medicine to lower their blood sugar, before frank diabetes develops.
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