Diagnosing type 2 diabetes and identifying high-risk individuals using the new glycated haemoglobin (HbA1c) criteria

Up to 30% of people with type 2 diabetes remain undiagnosed in the UK on average for 7 years, and complications are already present at diagnosis in about 50% of people.1,2 Furthermore, impaired glucose regulation or ‘high risk of diabetes’ (prediabetes, impaired glucose tolerance, and.or impaired fasting glucose)1,2 is highly prevalent, at around 15% in adults, and carries an increased risk of progression to type 2 diabetes and vascular complications. Early initiation of lifestyle and therapeutic measures significantly reduces long-term complications of diabetes. Furthermore, intensive lifestyle intervention and/or pharmacotherapy reduce progression to diabetes by 40.60% in individuals at high risk of diabetes. Accurate diagnosis of diabetes and routine screening to identify high-risk individuals is important to improve outcomes. Availability of a simple, accessible, and reliable diagnostic test is crucial. Diagnosis of diabetes has been traditionally based on plasma glucose measurements.3 The fasting plasma glucose (FPG) test is more commonly used on pragmatic grounds but still involves overnight fasting and has modest sensitivity for detecting diabetes compared to the oral glucose tolerance test (OGTT).4 In contrast, the OGTT is sometimes considered as the ‘gold standard’ test but has poor test reproducibility and is inconvenient and costly.4 Furthermore glucose measurement can …