How to Diagnose Diabetes? Practicalities and Comments on the WHO Provisional Recommendation in Favour of HbA1c

Abstract

Recently on British television, comedian Harry Hill settled similar arguments with a fight. Gladly there were no fisticuffs in Stockholm at the EASD-ADA joint symposium, entitled “Provisional new WHO diagnostic criteria 2010”. Professor Sir George Alberti began by outlining the history and background to this issue. Previous committees had examined, but rejected HbA1c as recently as 2006 (table 1). A major barrier had been lack of standardisation for the old DCCT-aligned assay methodology. Since the widespread adoption of the IFCC standard for HbA1c (2008), most diabetes associations have made recommendations in favour of HbA1c and Alberti went on to explain why, despite many detractors, the WHO Technical Guideline Development Group has now done the same. Whilst accepting that HbA1c-based diagnosis will not ‘capture’ exactly the same group of patients as an OGTT, he was keen to remind his audience of the “chaos” that reigned prior to acceptance of a worldwide standard in 1979. He proposed that a move to HbA1c would represent a change on an altogether smaller scale.