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In article <01bebd47$28f009a0$LocalHost@default>, Roy Fisher <[log in to unmask]> writes > We are getting an increasing number of HbA1c requests from GPs in > order to assess patients for possible DM. > I would be interested to hear how other colleagues deal with this > problem. Should we not be doing the test in this situation? > The WHO does not define diabetes mellitus (DM) in terms of glycohaemoglobin (GHb/HbA1c) so by definition we can't use GHb alone to diagnose DM. However.. A raised GHb indicates a prolonged high average blood glucose concentration in virtually all cases. It is good for 'ruling in' diabetes and in my view is certainly a useful test to help confirm suspected diabetes. In the diabetes clinic we find GHb *is* a reliable test (in contrast with blood glucose readings). Provided that patient does not have a shortened red cell lifetime we are more than pleased if we can get the GHb down into the reference range. Although good GHb/glycaemic control is important in preventing microvascular complications in DM, it is in fact *macrovascular* disease that causes most cases of premature death. Macrovascular disease is related to the metabolic syndrome (Reaven's, X) and abnormal lipid metabolism. Even when GHb has been brought down into the reference range by treatment it is essential to continue to treat lipid abnormalities in these patients. Robin Marks Halifax UK. \/ \/ \/ \/ \/ \/ \/ /\____/\____/\____/\____/\____/\____/\____ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%