Oral Glucose Tolerance Test (OGTT) vs HbA1c: Which Test Is More Reliable For Diagnosing Diabetes?

 Experts now recommend a combined and individualised approach, considering risk factors such as age, symptoms, family history, and other related conditions to determine which test to administer.

 Diabetes is diagnosed using blood tests that measure glucose (sugar) levels. In the early stages of the disease, symptoms may not be obvious, making routine screening essential for those at risk, such as individuals with obesity or a family history of diabetes. Detecting diabetes early or at the prediabetes stage can be a game-changer because it allows for interventions before permanent damage occurs. There are different blood tests used to diagnose diabetes mellitus, with the four most common being HbA1c, fasting plasma glucose, oral glucose tolerance test (OGTT), and random blood glucose levels. Each of these tests has its significance depending on the patient.

HbA1c vs. Oral Glucose Tolerance Test (OGTT)

HbA1c

The HbA1c test reflects your average blood sugar levels over the last two to three months. It measures how much glucose is attached to haemoglobin in your blood. The good thing about this test is that you don't have to do it in a fasting state.

It also gives a picture of how well your blood sugar levels are controlled over time. Doctors use HbA1c test results to understand your blood sugar control over a period of time. It's particularly useful for monitoring diabetes and identifying persistently elevated blood sugar levels.

Limitations of HbA1c

However, the HbA1c test may not be as accurate for individuals with anaemia, various types of hemoglobin disorders, or other medical issues affecting red blood cells. It may also miss early or fluctuating problems with blood sugar levels, particularly in younger individuals or those just beginning to develop insulin resistance.

OGTT

The OGTT, on the other hand, evaluates how the body manages a glucose load in real time. After fasting for at least eight hours, a person drinks a standard glucose solution, and blood sugar levels are measured over several hours. This test is particularly effective in detecting early signs of glucose intolerance, especially when fasting blood sugar levels are normal but rise significantly after eating.

The OGTT is beneficial for diagnosing gestational diabetes and identifying individuals at risk of developing diabetes later on. However, it is more time-consuming, requires some preparation, and may be less convenient for routine use. Fasting glucose levels are measured after at least eight hours of fasting, while random blood glucose levels are assessed without regard to fasting.

Which one is better at diagnosing diabetes?

From a clinical perspective, the reliability of a test depends on the specific situation. The HbA1c test offers a consistent picture over a longer duration, while the OGTT reveals how the body responds to glucose stress in the short term. In some early or borderline cases, the OGTT can identify issues that the HbA1c test might overlook. Conversely, HbA1c is more effective for long-term monitoring.

Experts now recommend a combined and individualised approach, considering risk factors such as age, symptoms, family history, and other related conditions to determine which test to administer. In certain cases, both tests may be necessary to ensure an accurate diagnosis and to avoid misclassification.

Ultimately, there is no single test that is ideal for every situation. Understanding what each test measures enables doctors to make better diagnoses and implement timely interventions, which is crucial for preventing serious long-term health complications associated with diabetes.

 

 

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Research finds ultrasound scans can diagnose prostate cancer

The one things that rings bell in everyone’s minds and makes them scared is when they’re asked to take an MRI, the procedure that is used to detect cancer. But, new research has found that the good old ultrasound scan can also be used to detect cancer. The research found that ultrasound tests can be used to detect cases of prostate cancer.

Researchers have found a new type of ultrasound scan can diagnose most prostate cancer cases with good accuracy in a clinical trial involving 370 men.

The ultrasound scans missed only 4.3% more clinically important prostate cancer cases—cancer that should be treated rather than monitored- compared to magnetic resonance imaging (MRI) scans currently used to detect prostate cancer.

MRI scans are expensive and time-consuming. The team believed that an ultrasound scan should be used as a first test in a community healthcare setting and in low and middle-income countries which do not have easy access to high-quality MRI scans.

They said, it could be used in combination with current MRI scans to maximize cancer detection. The lead author of the study said, “ prostate cancer is the most commonly diagnosed cancer in the UK. One in 6 men will be diagnosed with the disease in their lifetimes and that figure is expected to rise.”

MRI scans are one of the tests we use to diagnose prostate cancer. Although effective these scans are expensive, take up to 40 minutes to perform and are not easily available to all. Also, there are some patients who are unable to have MRI scans such as those with hip replacements or claustrophobia fears. As cancer waiting lists build as a result of the COVID-19 pandemic, there is a real need to find more efficient and cheaper tests to diagnose prostate cancer, he added.

Out study is the 1^st to show that a special type of ultrasound scan can be used as a potential test to detect clinically significant cases of prostate cancer. They can detect most cases of prostate cancer with good accuracy, although MRI scans are slightly better, he said.

We believe that this test can be used in low and middle-income settings where access to expensive MRI equipment is difficult and cases of prostate cancer are growing, he said.

Prostate cancer is the most common cancer in men in the UK with around 52,300 new cases diagnosed each year. It develops when cells in the prostate grows in an uncontrolled way. Prostate cancer develops slowly and symptoms such as the blood in the urine do not appear until the disease has developed. It usually affects men over 50 and often men with a family history of the disease. Black men are disproportionately impacted by the disease and deaths from prostate cancer have now overtaken those from breast cancer.

One of the main methods to diagnose prostate cancer is a special type of magnetic resonance imaging (MRI) scan called a multi-parametric MRI (mpMRI) scan, which helps doctors see if there is  any cancer inside the prostate and how quickly the cancer is likely to grow. However, the scan takes 40 minutes and costs 350-450 pounds.

The new study looked at the use of a different kind of imaging called multi-parametric ultrasound (mpUSS), which uses sound waves to look at the prostate. The test involved the use of a probe called a transducer to make the images of the prostate. It is placed into the rectum and it sends out sound waves that bounce off organs and other structures. These are then made into pictures of the organs.

The doctor doing the test also used extra special types of ultrasound imaging that look at how stiff the tissue is and how much blood supply tissue has. These are called elastography, Doppler and contrast-enhancement with micro-bubbles. As cancers are denser and have a greater blood supply, they show up more clearly.

Although mpUSS is more widely available than mpMRI there has been no large-scale studies to validate its effectiveness as a test to detect prostate cancer cases.

In the new trial, called cancer diagnosis my multi-parametric ultrasound of the prostate (CADMUS), the team recruited 370 men at risk of prostate cancer. They were identified following initial tests such as a prostate-specific antigen (PSA) test- a blood test to help detect prostate cancer- and / or an abnormal digital rectal examination- a test that examines a person’s lower rectum, pelvis and lower belly.

The study took place at 7 hospitals in the UK including lead site Charing Cross Hospital, part of Imperial College Healthcare NHS Trust, between March 2016= November 2019t.

The men were given both mpUSS and mpMRI scans at separate visits. This was then followed by biopsies- which involves using then needles to take small samples of tissue from the prostate to analyse under a microscope to check cancer- for 257 patients who had a positive mpUSS or mpMRI test result. The team then compared the results from the tests.

Cancer was detected in 133 men, with 83 men diagnosed with clinically significant cancer.

Individually, mpUSS detected 66 cases if clinically significant cancer compared to mpMRI which detected 77 cases.

Although mpUSS detected 4.3 % fewer clinically-important prostate cancers compared to mpMRI the researcher said his method would lead to 11.1 % more patients being biopsied. This was because the mpUSS sometimes showed up in abnormal areas even though there was no cancer.

The researchers believe that the test can be used as an alternative to mpMRI as a 1^st test for patients at risk of prostate cancer, particularly where mpMRI cannot be carried out. Both imaging tests missed clinically-important cancers detected by the other, so using both would increase the detection of clinically important prostate cancers compared to using each test alone.

The 1^st author said, our results provide an accurate test for prostate cancer in patients who were previously without one using a scan that’s cheap and easy to conduct.

 

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