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Using glycated haemoglobin testing to simplify diabetes screening in remote Aboriginal Australian health care settings

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Early identification of diabetes and associated complications provides an opportunity to start effective preventive treatment that reduces the subsequent development or progression of macrovascular and microvascular disease.13 However, diabetes remains undiagnosed in up to 50% of people with the disorder.24

Delayed diagnosis is due in part to the use of an algorithm that relies on the assessment of glucose levels and, if the results are equivocal, a follow-up oral glucose tolerance test (OGTT).5 This complicated algorithm can significantly delay informing and educating the patient.6 In contrast to glucose testing, assessment of glycated haemoglobin A (HbA1c) requires no fasting.7 This makes it more suitable for opportunistic testing, and results in fewer missed diagnoses.8

The American Diabetes Association (ADA) guidelines have included laboratory HbA1c testing for diagnosing diabetes since 2010.7 HbA1c testing is endorsed by the World Health Organization,9 and is recommended for diagnosing…