NEW YORK (Reuters Health) - A simple test that measures long-term blood sugar may help identify millions of people with undiagnosed type 2 diabetes, US researchers report.

The test, known as hemoglobin A1c ( HbA1c), provides information on a person's average blood sugar (glucose) over the past 2 to 3 months and does not require fasting. Although the fasting plasma glucose test is still considered the most accurate measure, HbA1c may be more pragmatic because it does not require patients to fast for several hours beforehand.

More than 5 million Americans have undiagnosed diabetes, the researchers note. If not controlled, the disease can lead to serious medical complications such as heart disease, blindness, kidney damage and amputations resulting from damage to nerves.

Currently, however, there is no clear evidence to support widespread screening at the doctor's office. While the new findings do not show that the HbA1c test is a cost-effective way to do routine screening, they do suggest that more cases of diabetes can be caught, according to the report in the January issue of the Journal of General Internal Medicine.

The study also shows that targeting certain patients for routine screening may increase the likelihood of developing a cost-effective way to screen, Dr. David Edelman from the Durham Veterans' Affairs Medical Center and Duke University in Durham, North Carolina, told Reuters Health.

``Simple risk factors--hypertension (high blood pressure), weight more than 20% over ideal, and history of diabetes in a parent or sibling--can be used to identify patients at highest risk of diabetes and, therefore, at greatest need for screening,'' he said. ``This improves the likelihood that a healthcare provider could perform cost-effective diabetes screening.''

The researchers administered an HbA1c test to more than 1,200 men aged 45 to 64 who had not been diagnosed with diabetes but were under the care of a doctor. Patients with slightly elevated results received the fasting plasma glucose test.

Nearly 5% of patients were found to have diabetes--a rate similar to that seen in men in the same age group in the general population, the report indicates. The test was particularly effective at detecting new cases of diabetes in obese individuals, those with high blood pressure and individuals with a family history of the disease.

An estimated 16 million Americans have been diagnosed with type 2 diabetes, but medical experts say the figure is actually higher.

SOURCE: Journal of General Internal Medicine 2002;17:1-7.

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