To the Editor: In our article1
we advised against diagnosing diabetes mellitus in individuals with normal
or only slightly elevated HbA1C levels. However, we take issue
with several points raised in the editorial by Dr Vinicor2
that accompanied our article.
We agree with Vinicor that there will be both false-positive and false-negative
results using our alternative approach to the diagnosis of diabetes. Regarding
false-positives, Vinicor cites the 2.8% prevalence of increased HbA1C levels in NHANES III subjects with normal FPG concentrations. However,
by definition, 2.5% of a normal population will have values 2 SDs above the
normal range. Only 0.1% had an HbA1C level exceeding 1% above the
upper limit of normal. This level was selected as diagnostic because 4 studies
showed almost no development or progression of retinopathy or microalbuminuria
over 6 to 10 years in patients with either type 13,4
or type 25,6 diabetes
with lower values. If our alternative approach to the diagnosis of diabetes
had been used to characterize the NHANES III population, neither false-positive
nor false-negative diagnoses would have occurred because HbA1C
levels would not have been measured in subjects with normal FPG values or
those of 7.8 mmol/L (140 mg/dL) or more.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.