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Correspondence
Challenges of diagnosing diabetes in endurance athletes
  1. Giuseppe Lippi1,
  2. Cantor Tarperi2,
  3. Martina Montagnana1,
  4. Elisa Danese1,
  5. Gian Luca Salvagno1,
  6. Federico Schena2
  1. 1Section of Clinical Biochemistry, University of Verona, Verona, Italy
  2. 2School of Sport and Exercise Sciences, University of Verona, Verona, Italy
  1. Correspondence to Professor Giuseppe Lippi, Section of Clinical Biochemistry, University of Verona, Verona 37100, Italy; giuseppe.lippi{at}univr.it

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The American Diabetes Association, in its updated 2018 Standards of Medical Care in Diabetes, has reinforced the recommendations that diabetes mellitus should be diagnosed when fasting plasma glucose (FPG) is >7.0 mmol/L, random plasma glucose (RPG) is >11.1 mmol/L, haemoglobin A1c (HbA1c) is >48 mmol/mol or the 2-hour plasma glucose after an oral glucose tolerance test is >11.1 mmol/L.1 Nevertheless, these straightforward recommendations may be challenged by a number of variables, which may ultimately decrease the diagnostic performance of these tests. Some preanalytical and biological factors are known to impair the diagnostic efficiency of both FPG and RPG, including acute stress, poor glucose stability in blood tubes after collection2 and drugs interference,3 so making HbA1c a more solid and reliable parameter for measuring and monitoring the glycaemic state under these and other conditions. Some previous studies showed that plasma glucose and HbA1c may be acutely influenced by endurance running4–6 and that erythrocyte metabolism and survivor may be disrupted during moderate to strenuous exercise due to various causes (ie, foot strike haemolysis, acute variations of plasma volume, improved oxygen release and deformability, alteration of glucose availability and uptake),7 so that the measurement of both plasma glucose and HbA1c may become potentially misleading for diagnosing diabetes. Therefore, the aim of this study was to investigate the variations of plasma glucose and HbA1c up to 24 hours after a half-marathon run in trained …

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