Population Health Intervention Research Centre, Calgary Institute of Population and Public Health, University of Calgary, 3280 Hospital Drive, Calgary, Alberta, Canada.
J Med Ethics. 2012 Mar;38(3):180-3. doi: 10.1136/medethics-2011-100086. Epub 2011 Oct 4.
Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for individual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the individual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health.
自 20 世纪 90 年代以来，糖化血红蛋白（HbA1C）一直是监测 1 型糖尿病（T1DM）或 2 型糖尿病（T2DM）患者血糖控制的金标准。目前正在讨论基于 HbA1C 滴度诊断糖尿病和使用 HbA1C 检测筛查 T2DM 的问题。这些讨论主要集中在对个体患者的相对益处上，同时也关注医疗保健系统成本的降低和对社会的益处。我们认为，采用基于 HbA1C 的诊断和 T2DM 筛查有很强的伦理理由，但尚未得到明确阐述。其基本原理包括基于 HbA1C 的糖尿病检测对弱势群体的不同影响，以及我们开始了解 HbA1C 与人群健康的关系。虽然有人认为筛查必须主要使个人受益，但使用 HbA1C 诊断和筛查 T2DM 可能会促进更公平地分配卫生资源，并有助于调查、监测和解决健康的社会决定因素。
