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Given that the proposed HbA1c diagnostic for screening are both insensitive and racially discrepant, what is the optimal way to screen for diabetes? Dr. Rhee recommended that doctors perform the standard 75 gram OGTT, or, at the very least, a fasting glucose level followed by the OGTT in individuals whose levels are abnormal (100 mg/dL and above).
She emphasized, however, that the HbA1c remains a useful tool for monitoring diabetes.

 

About one person in one hundred with hypertension has elevated levels of aldosterone; in these persons, the antihypertensive effect of spironolactone may exceed that of complex combined regimens of other antihypertensives. Due to its antiandrogen effect, it can also be used to treat hirsutism, and is a common component in hormone therapy for male-to-female transsexual and transgender people.
Findings from a recent study, she said, suggest that the 50 gram glucose challenge test, a test used to screen for gestational diabetes in pregnancy, may represent a promising alternative to HbA1c as a screening test for diabetes or prediabetes (Phillips et al. Diabetologia. 2009;52:1798-1807) because it has been shown to be accurate and can be readily performed during office visits at any time of the day and without a prior fast.

 

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