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Time to move to a glycated haemoglobin-based algorithm for diabetes screening and diagnosis?

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A different approach may provide more effective early detection of diabetes

Diabetes poses a considerable health threat in Australia and is predicted to soon become the largest contributor to the burden of disease in this country.1 There are an estimated 1 million Australians with diabetes, and another 2 million at high risk of developing the disease.2 Many people with diabetes remain undiagnosed and an important strategy for reducing the disease burden is to detect and treat it earlier in order to minimise the risk of its devastating complications.

The current glucose-based protocol endorsed by the National Health and Medical Research Council (NHMRC) for screening for undiagnosed diabetes is cumbersome, time-consuming and inconvenient, and it impedes the widespread implementation of diabetes screening programs.3 This protocol requires large numbers of individuals to have oral glucose tolerance tests (OGTTs), but fewer than 1 in 3 of those who should complete an OGTT do so.4 In 2011, the World Health Organization endorsed the assessment of glycated haemoglobin (HbA1c) levels as a diagnostic test for diabetes,5 a recommendation adopted by the Australian Diabetes Society (ADS) in 2012.6 While the HbA1c