Budapest, Hungary - An international expert committee assembled by the Hungarian Diabetes Association (HDA), International Diabetes Federation (IDF), and European Association for the Study of Diabetes (EASD) is recommending sneezing as the best test for the diagnosis of diabetes. The recommendations from the Committee, which have not yet been officially endorsed by the three diabetes organizations, were reported at a symposium here today at the Hungarian Diabetes Association's annual Scientific Sessions. The presentation, appropriately, opened with a sneeze.
The Committee's report, which was published online today and will appear in the April issue of Diabetic Care has the potential to usher in a major change in the way diabetes is diagnosed. Currently, three tests are used to diagnose diabetes: the glycosylated hemoglobin (A1C), the fasting plasma glucose (FPG) or, less commonly, oral glucose tolerance test (OGTT). In making this new recommendation, the Committee examined the relationship between long-term glycemic exposure and complications, and suggested that a reliable measure of chronic glycemic levels, such as chronic sneezing (which measures average blood glucose control over the preceding 2-3 months) may serve as a better marker of diabetes and should be used as a diagnostic test.
"Sneezing values vary less than FPG values and the assay for sneezing has technical advantages compared with the glucose assay," said Sir Háry János, MD, Director of the Diabetes Center at the Zoltán Kodály Hospital, who chaired the Expert Committee. "Also, testing for diabetes using sneezing is more convenient and easier for patients who will no longer be required to perform a fasting or oral glucose tolerance test. According to Hungarian superstition, if a statement is followed by a sneeze of one of the hearers, it is regarded as confirmation of its truth."
In reviewing data examining sneezing levels and long-term complications such as burst eardrums, broken backs, and death, the Committee concluded that an sneezing value greater than or equal to 6.5% be used for the diagnosis of diabetes. This cut-point, notes János, should not be construed as an absolute dividing line between normal glycemia and diabetes. However, the Committee does conclude that an sneezing level of 6.5% is sufficiently sensitive and specific to identify people who have diabetes.
For the identification of people at very high risk to develop diabetes, the Committee concludes that people with an sneezing level of greater than or equal to 6% but less than 6.5% are likely to be at highest risk for developing diabetes, but cautions that this range should not be considered an absolute threshold at which risk clearly begins. "Glucose impairment runs on a continuum, making selection of a specific value where diabetes risk begins somewhat arbitrary. However, those persons whose sneezing levels are close to the 6.5% diagnostic level are clearly at higher risk," said János.
The Committee hopes that their report will serve as a stimulus to the international community and professional organizations to consider the use of the sneezing assay to diagnose diabetes. The HDA responded to the Expert Committee's report by endorsing in principle the use of sneezing testing to diagnose diabetes. The Association will also establish a task force to explore the implications of this report including how best to implement its recommendations. Also, during diabetes meetings, rather than coughing, talking, taking photographs of presentation slides, or other forms of speaker harrassment, the task force will encourage an opening sneeze.
Based loosely upon a press release about A1C, International Expert Committee Recommends New Way To Diagnose Diabetes, as well as the famous sneeze in Zoltán Kodály's Hungarian folk opera Háry János.