A new report by the Centers for Disease Control and Prevention in the United States has claimed that the use of the haemoglobin A1c (HbA1c) test to diagnose pre-diabetes is a cost-effective measure if the threshold for diagnosis is set at 5.7 per cent.
The organisation also said that when the cost of treating patients with an HbA1c level lower than 5.7 per cent would be likely to outweigh the savings that can be made from an improvement in long-term outcomes. The study, published in the American Journal of Preventive Medicine, showed that such a diagnostic cut-off level would not lie within the US$50,000 per quality life-year gained, which is usually thought to be the most cost-effective.
The pre-diabetes diagnosis threshold has been a matter for keen discussion in the US since 2009, when the American Diabetes Association began recommending it as the new standard diagnostic test for both diabetes and pre-diabetes. Although the CDC suggested 6.5 per cent as the most effective cut-off level for diabetes, the best level of pre-diabetes has tended to be set anywhere from 5.5 per cent to 6.0 per cent by professional organisations.
The report commented “Establishing an HbA1c cutoff for pre-diabetes, however, has been more challenging than for diabetes because the relationship between the incidence of type 2 diabetes and HbA1c below 6.5 per cent is continuous, with no clearly demarcated threshold that is associated with an accelerated risk of diabetes or other morbidities.”

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