Presidents' statement on WHO recommendation on HbA1c for diabetes diagnosis.

Diabetes is a common and serious condition which results in premature mortality, significant morbidity and has a considerable economic impact. A diagnosis of diabetes has important implications for the individual. It not only commits them to a lifetime of treatment but also may affect work opportunities and social interactions, underlining the importance of making a correct diagnosis. While relatively easy to diagnose in people who are symptomatic, the diagnosis of diabetes may be challenging in an asymptomatic individual. Since 1965 the WHO has published several guidelines for the diagnosis of diabetes. The last report published in 2006 confirmed the central role of fasting and post oral glucose tolerance test plasma glucose for diagnosing diabetes [1]. The potential utility of HbA1c in the diagnosis of diabetes was considered by a number of WHO consultations and each HbA1c is recommended as a diagnostic option in addition to and not replacing previously defined diagnostic tests. The use of HbA1c as a diagnostic option for diabetes is dependent on meeting stringent quality assurance tests, assays being standardised to criteria aligned to the international reference values, and also that there are no conditions present which preclude the accurate measurement of HbA1c. In particular, HbA1c is unreliable in medical conditions with rapid red cell turnover, such as haemolytic or iron deficiency anaemias, haemoglobinopathies (depending on the assay employed) and disorders associated with accelerated red cell turnover such as malaria. Therefore in many countries and locations throughout the world, HbA1c testing will not be a practical option for diagnosing diabetes at this time. Cost also represents a major barrier to the adoption of this recommendation in many parts of the d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 9 3 ( 2 0 1 1 ) 3 1 0 – 3 1 1