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A 57-year-old white man with obesity and hypertension presents for a primary care visit, during which he expresses concern about having diabetes. He reports no symptoms of hyperglycemia, such as frequent urination, increased thirst, fatigue, or visual changes, and had no known family history of diabetes. A series of blood tests had recently been obtained (Table). His body mass index (BMI) is 33.9 and his blood pressure is 160/90 mm Hg. The patient wants to know if a test could be done in the office to determine if he has diabetes.
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C. Perform a laboratory-based HbA1c test to determine the patient’s glycemic status.
Hemoglobin A comprises approximately 97% of total hemoglobin and undergoes glycation with the nonenzymatic attachment of a sugar to its amino groups. Hemoglobin A1c (HbA1c) has glucose attached to the N terminus of β chains. The quantity of HbA1c is directly related to the glucose concentration that erythrocytes are exposed to over their life span, making HbA1c a clinically useful measure of mean glycemia during the preceding 3 months. Type 2 diabetes is defined by an HbA1c value of at least 6.5%, and prediabetes is defined by an HbA1c value of 5.7% to 6.4%. Individuals with prediabetes have an increased risk of developing type 2 diabetes, estimated at 5% to 10% annually and 70% in a lifetime.
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Corresponding Author: Matthew J. O’Brien, MD, MSc, Northwestern University, Feinberg School of Medicine, 750 N Lake Shore Dr, Sixth Floor, Chicago, IL 60611 (email@example.com).
Published Online: September 12, 2019. doi:10.1001/jama.2019.14063
Conflict of Interest Disclosures: Dr O’Brien reported receiving support from the National Institute of Diabetes and Digestive and Kidney Diseases (R21-DK112066) and personal fees from Novo Nordisk. Dr Sacks reported receiving support from the National Institutes of Health Clinical Center Intramural Program and grants from the National Institutes of Health and serving as the chair on the National Glycohemoglobin Standardization Program steering committee.
Additional Contributions: We thank the patient for providing permission to share his information.
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