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March 26, 1982

Glycosylated Hemoglobin Measurements and Diabetes

JAMA. 1982;247(12):1696. doi:10.1001/jama.1982.03320370014011

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To the Editor.—  The glycosylated hemoglobin (Hb A1) test results used to estimate the prevalence of unrecognized diabetes among patients admitted to a coronary care unit are of interest; however, I was a bit stressed by the conclusions of Norman G. Soler, MD, PhD, and Stuart Frank, MD (1981;246:1690). The word practical is used, and I question this for several reasons. First, no mention is ever made of therapy decisions made at discharge (or at a three-month follow-up) based on elevated Hb A1 values. Second, although the authors state "An FPG [fasting plasma glucose] level of more than 140 mg/dL following an acute MI, in the absence of an elevated Hb A1 value, indicated severe stress rather than previously unrecognized diabetes," I do not find data to support this. Specifically, there is no mention of follow-up FPG and Hb A, levels in the 21 patients that fall into this