New Guidelines Call for Using A1C Blood Test to Identify People With Prediabetes
WebMD Health NewsReviewed by Brunilda Nazario, MDDec. 29, 2009 – The American Diabetes Association (ADA) is recommending that a simple blood test currently used to assess whether diabetes is under control also be used to diagnose the disease.
The blood test – known as the A1C test – has several important advantages over traditional blood glucose testing.
Patients do not need to fast before the test is given, and it is far less likely to identify clinically irrelevant fluctuations in blood sugar because it measures average blood glucose levels over several months.
The new guidelines do not call for replacing traditional screening with the A1C test.
It is believed that around 6 million Americans have diabetes but don’t know it, and another 57 million have prediabetes.
The A1C test may help identify a large number of people in both of these groups, former ADA president for medicine and science John Buse, MD, PhD, tells WebMD.
Buse, who is chief of endocrinology at the University of North Carolina, Chapel Hill, helped draft the new ADA diabetes care guidelines, which were made public today.
“We now know that early diagnosis and treatment can have a huge impact on outcomes by preventing the complications commonly seen when diabetes is not well controlled,” he says. “Our hope is that people with early or prediabetes who might otherwise not be tested would have the A1C test.”
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My question is where the H#$#$@# has the ADA been. I am a T2 and should have been treated long ago. Thinking back I could have been on Metformin 5-8 years ago… Bernstein would have treated me immediately back then and he has been advocating this for years…Finally the bells are ringing… duhhhh
I still have some unresolved anger over my diagnosis. Several years of fasting levels that even at the time were a confirmed diabetes diagnosis. The fasting blood sugar is the last thing to go. As it was, I guess having an HbA1c of 8%, it could have been worse, but still.
On another note, it is interesting to see the amount of confusion at the ADA and press about what this means. I believe this is a change in clinical practice to now routinely use the HbA1c to “Screen” for diabetes.
The short answer that A1C is not entirely new test and it been utilized by medical community for some years. Having said that prior technology and reagents didn’t provide 100% accuracy and adequacy to be endorsed as ADA golden standards and reliable indication factor until now. Better late then never
I hear you, the fasting levels can be somewhat misleading sometime due to common “dawn effect” that indicate slightly eleveted levels of A1C
The best way to get that straight is to schedule apointment, for second opinion, with Board Certified Endocrinology specialist.
Thanks Igal. Just had to get it off my chest little by little I guess…
I think you are right. What concerned me was that for several years, my routine fasting blood sugar tests were high, not just pre-diabetic, but consistently over 125 mg/dl and my doctor never even mentioned them. I have to presume if the new HbA1c screening had been in place I would have been diagnosed several years earlier.
bsc…but would a fasting BS over 125 ( 7.0 in Canada ) as you mentioned not be a reason for further testing , regardless of the availability of an A1C , which Doc may not have shared the result of either with you ?
I hope you were " upset " with your Doc and did something about it ?
I am not familiar with Canadian health system and clinical practice standards…
US standards of care require routine, every 3 months A1C testing for Diabetics in addition to recommended Lipid (HDL/LDL ratio) and Renal (GFR/Createnin) panels for early detection of diabetes related complications. US patients are entitled to acquire their own lab results which usually mail with physician interpretation and recommendation.
I personally have virtual online access to my own and entire family labs,. meds and any other medical records not mention online secured communication with my Kaiser doctor
That was the doctor I fired before I fired my doctor that I got after my doctor moved (misfired) and before I got another doctor that I fired as well. But then I got a new doctor, and he is gone, but I got a new one, who I got really irritated at since she wanted my HbA1c over 7% and suggested I see either another endo or a psychiatrist. So I chose to see a new endo.
Like I said, I still have unresolved anger issues.
Thanks, I feel better talking about it.
Excessive stress and depression are very critical clinical factors associated with uncontrolled diabetes.
I suggest you see both specialist and connect them with each other for synchronized care plan. In addition it is recommended to attend accredited Diabetes Self Management Training program.
You can locate ADA accredited/recognized program in your area via ADA web site or ask your Endo doctor for formal referral.
The good news are that your insurance plan must approve and cover 100% based on your Diabetic diagnosis. The only possible exception is Medicaid. State of California Medi-Cal decline to cover that despite Federal Regulations from 2000 recorded in Federal Registry
Yeah… I went to the doctor back in May, concerned that (using my husband’s glucometer) my postprandial BG level was 152… and, I mean, that’s not horrifyingly high… but the doctor ignored it as normal, and I trusted her… They didn’t call for any more tests until mid November, when my yeast infections would not go away, and my fasting BG got to 235. I had an a1c of 10.5%. I sure could’ve gotten on the ball a lot earlier, had they not been screwing around with it.
bsc : Tu friends no doubt are here to listen …amazing how we all find some medically trained persons out there in the Universe with so little understanding about this chronic disease and …it is very complex .Good on you ,that you keep on being pro-active advocating for YOU .Besides: you seem to deal with your unresolved anger issues .
All the best for 2010 .
Igal , I don’t know how to get the Canadian Diabetes ■■■’ n 's Clinical 2008 guidelines here ( not comp . savvy …maybe one day ) without typing , typing and typing …here is what I found in " short form " : CDA type 2 A1C < 6.5% ( must be balanced against risk of hypo )
A fasting plasma glucose level of 7.0 mmol/L ( x 18 ) correlates most closely with a 2- hour plasma glucose value of 11.1 mmol/L ( x 18 ) in a 75-oral glucose tolerance test .To be performed every 3 years in individuals >40 years of age. (More often when in the high risk group )
While the FPG is the recommended screeing test a 2- hour plasma glucose in a 75- g oral glucose tolerance test is indicated when the FPG is 6.1 to 6.9 mmol/L and maybe indicated when a FPG is 5.6 to 6.0 mmol/L and suspicion of type 2 or impaired glucose tolerance is high ( in ind. with risk factors ) .
I hope this is somewhat helpful to your discussion and my question to poster bsc.
I am looking forward to the day , that I can obtain online access to my medical history; it is been worked on I understand here in my province .
Just a quick - YES. Always. I think every diabetic should. Funny, I didn’t know what one was until years after I was diagnosed and I was in the hospital with a 400+ BS and 12 A1C.
I now am tested every 3 months and my endo makes sure my GP Chick and Gastro Guy have the numbers.
And YEAH team it was 5 this month! Now if we can just get my iron level up . . . lol
Here’s to always being proactive!