International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes

  1. The International Expert Committee*
  1. Corresponding author: David M. Nathan, dnathan{at}

An International Expert Committee with members appointed by the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation was convened in 2008 to consider the current and future means of diagnosing diabetes in nonpregnant individuals. The report of the International Expert Committee represents the consensus view of its members and not necessarily the view of the organizations that appointed them. The International Expert Committee hopes that its report will serve as a stimulus to the international community and professional organizations to consider the use of the A1C assay for the diagnosis of diabetes.

Diabetes is a disease characterized by abnormal metabolism, most notably hyperglycemia, and an associated heightened risk for relatively specific long-term complications affecting the eyes, kidney, and nervous system. Although diabetes also substantially increases the risk for cardiovascular disease, cardiovascular disease is not specific to diabetes and the risk for cardiovascular disease has not been incorporated into previous definitions or classifications of diabetes or of subdiabetic hyperglycemia.


Diagnosing diabetes based on the distribution of glucose levels

Historically, the measurement of glucose has been the means of diagnosing diabetes. Type 1 diabetes has a sufficiently characteristic clinical onset, with relatively acute, extreme elevations in glucose concentrations accompanied by symptoms, such that specific blood glucose cut points are not required for diagnosis in most clinical settings. On the other hand, type 2 diabetes has a more gradual onset, with slowly rising glucose levels over time, and its diagnosis has required specified glucose values to distinguish pathologic glucose concentrations from the distribution of glucose concentrations in the nondiabetic population. Virtually every scheme for the classification and diagnosis of diabetes in modern times has relied on the measurement of plasma (or blood or serum) glucose concentrations in timed samples, such as fasting glucose; in casual samples independent of prandial status; or after a standardized …

| Table of Contents

This Article

  1. Diabetes Care vol. 32 no. 7 1327-1334
  1. Accompanying Editorial
  2. All Versions of this Article:
    1. dc09-9033v1
    2. 32/7/1327 most recent