Tests of Glycemia in Diabetes
- David E. Goldstein, MD123,
- Randie R. Little, PHD12,
- Rodney A. Lorenz, MD4,
- John I. Malone, MD5,
- David Nathan, MD6,
- Charles M. Peterson, MD7 and
- David B. Sacks, MD8
- 1Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri
- 2Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri
- 3Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri
- 4Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois
- 5University of South Florida College of Medicine, Tampa, Florida
- 6Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
- 7Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, Maryland
- 8Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
- Address correspondence and reprint requests to Randie R. Little, PhD, University of Missouri School of Medicine, Departments of Pathology and Anatomical Sciences and Child Health, M767, 1 Hospital Dr., Columbia, MO 65212. E-mail: littler{at}health.missouri.edu
- AACC, American Association for Clinical Chemistry
- ADA, American Diabetes Association
- AGE, advanced glycation end product
- CAP, College of American Pathologists
- DCCT, Diabetes Control and Complications Trial
- FDA, Food and Drug Administration
- GSA, glycated serum albumin
- GSP, glycated serum protein
- HPLC, high-performance liquid chromatography
- IFCC, International Federation of Clinical Chemistry
- NACB, National Academy of Clinical Biochemistry
- NGSP, National Glycohemoglobin Standardization Program
- SMBG, self-monitoring of blood glucose
- UKPDS, U.K. Prospective Diabetes Study
Monitoring of glycemic status, as performed by patients and health care providers, is considered a cornerstone of diabetes care. Results of monitoring are used to assess the efficacy of therapy and to make adjustments in diet, exercise, and medications in order to achieve the best possible blood glucose control.
The purpose of this review is to summarize current knowledge about the tests used most widely in monitoring the glycemic status of people with diabetes. The review addresses both patient- and physician/laboratory-based testing, and it includes tests of urine glucose and ketones and tests of blood glucose and glycated proteins (hemoglobin and serum proteins). The major emphasis is on the advantages and limitations of each test for routine clinical practice. Use of these tests for diabetes screening and diagnosis will not be addressed in this review. Since this review was first published in 1995, there have been many advances in the field, most notably standardization of glycated hemoglobin testing and new approaches to self-monitoring of blood glucose (SMBG), including minimally invasive continuous glucose monitoring over hours to days at a time. These and other advances are presented in detail in a recent report that was prepared by the National Academy of Clinical Biochemistry (NACB) and published as an American Diabetes Association (ADA) position statement (1). This review will attempt to complement, rather than duplicate, the material in the NACB report.
Conceptual framework
If there was an ideal method of monitoring glycemic status, it might be a small noninvasive device, perhaps similar to a wristwatch that people with diabetes could wear to continuously monitor their blood glucose level. The device would warn of impending hypoglycemia. It also would store blood glucose data and perform a variety of calculations such as hourly, daily, weekly, or monthly blood glucose averages. Unfortunately, such a monitoring device is …
