Diabetes A1c Test: New Use for an Old-Line Tool

Last updated: August 28, 2008

Last week I wrote about how the A1c test, the current gold standard for monitoring long-term blood sugar control in people with diabetes, may soon be replaced by a new measure, the estimated average glucose (eAG) test.

Now it appears the old A1c test may be put to new use. A team lead by an edocrinologist at the Johns Hopkins University School of Medicine is recommending that the A1c measure be used to identify potentially millions of people with undetected diabetes.

Current diagnostic tests designed to detect diabetes are limited, according to the team, as they only measure the amount of sugar present at the time a blood sample is taken. The A1c doesn't require a person to fast overnight, another significant advantage over both currently available screening tests: the oral glucose tolerance test and the fasting blood glucose test.

Diabetologists suggest the current screening tests may miss a significant portion of the population that has diabetes or is at high risk of developing the disease, since glucose levels can vary depending on a person's diet and activity for several days leading up to a blood draw. (And, let's be honest, who's going to admit to trying to skew results by skipping doughnuts and ice cream and taking a brisk walk in the days leading up to a sugar check?)

This national panel recently recommended that folks who score a 6 percent on an A1c test may be at risk for diabetes and should be followed closely. Those who hit 6.5 percent or higher should be considered to have diabetes, if a subsequent check confirms initial test results. Among seniors 70 and over, some geriatricians say shooting for a slightly higher A1c, around 7.5 percent, is more realistic. (And in the frail elderly, that number may climb even higher, depending on an individual’s other health concerns and whether or not diabetes-related complications are a factor.)

Speaking of shifting numbers -- exactly when diabetes is diagnosed and in whom -- is the subject of an eye-opening post by David Kliff, who has type 2 insulin-dependent diabetes, and blogs about the big business of diabetes at the Diabetic Investor. (His insights on the whole quandary about use of the term "pre-diabetes" is particularly illuminating, especially for anyone with numbers hovering in that gray zone.) And he weighs in wittily on the whole A1c vs. eAG debate.

Of course, all this talk about 6s and 7s begs the question: What's a person to do if he or she is concerned about being at risk for diabetes? Simple, ask a physician about the benefits of taking an A1c test instead of standard screening checks.

Whatever screening measure you and your doctor decide to use, don't wait to be tested. The sooner you find out if you have the disease the sooner you can take steps to prevent its brutal complications, which can damage the body from head to toe.

Image by Flickr user kr4gin used under the Creative Commons attribution license.

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Caring.com User - Theresa Garnero
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about 6 years ago

How refreshing to see we will use A1C for diagnostic screening. The main hesitation not to use it in the past was related to anemia ("hemoglobinopathies" as described in the panel link above). According to the research, that is rare and many more people would benefit by using the A1C as a screening tool. At the recent American Association of Diabetes Educator conference, the delightfully brilliant Dr. Lois Jovanovic outlined criteria for diagnosing type 2 diabetes in pregnant women including an A1C value of 5.3% or higher. (She also referred to the weapons of mass destruction being the fork and knife as it relates to our increasing waistlines and risk for diabetes.) Thank you for the link to David Cliff's Diabetes Investor. He is enjoyable to read and has many valid points, but I feel strongly about his catastropharian attitude that "industry... remain silent in the hopes that the 57 million consumers with "pre-diabetes" will develop full-blown diabetes, increasing the market for drugs and devices." From my practice standpoint in working in the largest diabetes center in California along with other diabetes educators and physicians who are doing everything they can to reduce a person's risk of the consequences of uncontrolled diabetes, I do not get the mentality that there is a man behind the curtain fiendishly wringing his hands thinking of ways to bilk money from those with or at risk for diabetes rather than find a cure. Without industry, we would not have many of the tools to make diabetes more manageable. It wasn't that long ago that we only had one oral medication for diabetes. Now we have many with others in development. Why is that same kind of logic not applied to other health conditions like heart disease or cancer? The health industry is a business, but I think we need to be careful before suggesting that industry is only out to make a buck. That myth is alive and well and deters those in need from seeking treatment as they feel they are being taken advantage of in some kind of warped conspiracy theory meanwhile putting themselves at risk for diabetes-related complications. The reality is, according to Dr. Ralph DeFronzo's Banting Lecture at the American Diabetes Association (he has hundreds of original research articles to his name), by the time a person gets diagnosed only 20% of beta cell function remain. Medications are often needed to preserve the rest and to control the disease. I totally agree with Clift's statement about "I don't have what you have syndrome" as many people with pre-diabetes still do not take action. I disagree with the concept that doctors are happily canvassing the prediabetes planet with medications and that industry "remains silent in hopes" folks will progress to diabetes. That's like saying the makers of chemotherapy eagerly await the next generation of first or secondhand smokers to develop cancer. Plus, physicians rarely prescribe medications for pre-diabetes as the "let's wait and see" approach remains prevalent. We are living longer, eating more, and moving less as a nation. Health issues are bound to arise. People often get their cholesterol checked annually but don't have a clue about glucose. Get your A1C test to screen for diabetes and have it checked regularly. You CAN take action and prevent needless complications. Theresa Garnero, APRN, BC-ADM, MSN, CDE

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