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Tests of Glycemia
- R Graham Barr, MD, DrPH;
- James B. Meigs, MD, MPH; and
- Daniel E. Singer, MD
- Columbia–Presbyterian Medical Center; New York, NY 10032 (Barr) Massachusetts General Hospital; Boston, MA 02114 (Meigs, Singer)
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IN RESPONSE:
We appreciate Dr. Davidson's clarification of Figure 2 in our article; the values of glycemia in the abscissa were minimum values for each decline. Nonetheless, we believe a threshold at which complications begin to occur can refer to the minimum, rather than the mean, of a decile. Fair-minded observers could disagree about the exact thresholds observed in the graphs, but increasing these by one decile only raises thresholds into the lowest “diabetic” range of glycemia (fasting plasma glucose level, 6.0 to 7.5 mmol/L [108 to 136 mg/dL], 2-hour postchallenge plasma glucose level, 8.6 to 13.5 mmol/L [155 to 244 mg/dL], and hemoglobin A1c level, 6.2% to 6.9%). Use of deciles, whether minimums, means, medians, or maximums, introduces arbitrary thresholds. Alternative nonlinear techniques, such as nonparametric splines or smoothing functions, might make identification of thresholds more precise, although the nonstatistical concerns about optimal thresholds for the diagnosis of diabetes remain.
In terms of the preferred tests of glycemia for the diagnosis of diabetes mellitus, we very much agree with Dr. Davidson's recommendation that hemoglobin A1c level should be used (1), particularly in combination with fasting plasma glucose. We stated this opinion in our paper (in Table 2 and in the accompanying text).
R. Graham Barr, MD, DrPH
Columbia–Presbyterian Medical Center; New York, NY 10032
James B. Meigs, MD, MPH
Daniel E. Singer, MD
Massachusetts General Hospital; Boston, MA 02114
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
