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Testing relationships: ethical arguments for screening for type 2 diabetes mellitus with HbA1C
  1. Chris Degeling1,
  2. Melanie Rock1,
  3. Wendy A Rogers2
  1. 1Population Health Intervention Research Centre, Calgary Institute of Population and Public Health, University of Calgary, Calgary, Alberta, Canada
  2. 2Philosophy Department and Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
  1. Correspondence to Dr Chris Degeling, Population Health Intervention Research Centre, Calgary Institute of Population and Public Health, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive, Calgary, Alberta T2N 4Z6, Canada; cjdegeli{at}ucalgary.ca

Abstract

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.

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Footnotes

  • Funding CD is funded through support from Alberta Innovates—Health Solutions Establishment and Incentive Grants (AI-HS to MR) and a University of Calgary Veterinary Medicine Postdoctoral Entrance Award. MR holds a Population Health Investigator award from Alberta Innovates—Health Solutions, which is funded by the Alberta Heritage Foundation for Medical Research Endowment. She also holds a New Investigator in Societal and Cultural Dimensions of Health Award from the Canadian Institutes for Health Research. WAR received no support from external funding for her contribution to this paper.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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