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Clinical Chemistry 48: 436-472, 2002;
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(Clinical Chemistry. 2002;48:436-472.)
© 2002 American Association for Clinical Chemistry, Inc.

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

David B. Sacks1a, David E. Bruns2, David E. Goldstein3, Noel K. Maclaren4, Jay M. McDonald5,6 and Marian Parrott7

1 Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Thorn 530, 75 Francis St., Boston, MA 02115.

2 Department of Pathology, University of Virginia Medical School, PO Box 800214, Charlottesville, VA 22908.

3 Department of Child Health, University of Missouri School of Medicine, 1 Hospital Dr., Columbia, MO 65212.

4 Weill Medical College of Cornell University, 1300 York Ave., Suite LC-623, New York, NY 10021.

5 Department of Pathology, University of Alabama at Birmingham, 701 S. 19th St., Birmingham, AL 35294.

6 Veterans Administration Medical Center, Birmingham, AL 35233.

7 American Diabetes Association, 1701 Beauregard St., Alexandria, VA 22311.

aAuthor for correspondence. Fax 617-278-6921; e-mail dsacks{at}rics.bwh.harvard.edu.

Background: Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially.

Approach: An expert committee drafted evidence-based recommendations for the use of laboratory analysis in patients with diabetes. An external panel of experts reviewed a draft of the guidelines, which were modified in response to the reviewers’ suggestions. A revised draft was posted on the Internet and was presented at the AACC Annual Meeting in July, 2000. The recommendations were modified again in response to oral and written comments. The guidelines were reviewed by the Professional Practice Committee of the American Diabetes Association.

Content: Measurement of plasma glucose remains the sole diagnostic criterion for diabetes. Monitoring of glycemic control is performed by the patients, who measure their own plasma or blood glucose with meters, and by laboratory analysis of glycated hemoglobin. The potential roles of noninvasive glucose monitoring, genetic testing, autoantibodies, microalbumin, proinsulin, C-peptide, and other analytes are addressed.

Summary: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are of minimal clinical value at the present time, and measurement of them is not recommended.




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