International Committee Urges Adoption of A1c as the Standard Test for Diagnosing Diabetes

A committee of experts at the recent ADA conference reported that it has set an A1c of 6.5% as the

Jun 17, 2009

The A1c test (also called the HbA1c test), which establishes average blood sugar levels over a three-month period, should replace fasting plasma glucose and oral glucose tolerance tests as the standard for diagnosing diabetes.

That's the recommendation of an internal committee of experts appointed by the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation. The committee, reporting at the 60th Scientific Sessions of the ADA, offered several reasons for its recommendation:

  • The A1c test establishes a two- to three-month average that is a more reliable figure than the "snapshot" numbers derived from a fasting plasma glucose or oral glucose tolerance test.
  • The test is easier on patients, who do not have to fast or do anything out of the ordinary other than give a blood sample.
  • The test is more resistant to loss of useful information than either of the glucose tests. For example, if blood samples from the fasting or tolerance tests take too long to reach a laboratory, they lose any measurable glucose. A1c samples, in contrast, retain their measurable constituents.

The committee reported that it has set an A1c of 6.5% as the "cut point" for diagnosing diabetes. In other words, individuals with A1c levels of 6.5% and above are considered to have the disease. Individuals with A1c levels running more than 6%, but not quite as high as 6.5%, are considered at high risk of developing type 2.

The committee also said that many doctors already independently undertake A1c testing on their patients because of its reliability and depth of data. Although making the A1c the new standard assay for diabetes would be a major departure, many members of the medical community would apparently have no problems making the transition to it.

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Categories: A1c Test, Blood Sugar, Diabetes, Diabetes, Health Research, Research, Type 1 Issues, Type 2 Issues

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Posted by Anonymous on 22 June 2009

If this standard had been in place when I was diagnosed with Type 1 eight years ago (at age 59!), I would not have been diagnosed as early as I was. My A1c at diagnosis was 6.0; my fasting glucose was 132 (with 126 qualifying for diagnosis). My GAD antibody and c-peptide levels determined that, despite my "advanced" age, I was Type 1 and not Type 2. So I don't think this new standard is a good idea.

Posted by Green Lantern on 23 June 2009

It's about time! The previous "gold standard" for diagnosing diabetes--the glucose tolerance test, or GTT, is notoriously unreliable (if you take it several days in a row, the results are different). And a spot fasting glucose tells you very little. Eight years ago, I was collaborating with a company that made an instant A1c reader to see if we couldn't get the standard changed to A1c, which was being used in Europe.

I'm not sure i'd set the "prediabetic" A1c at 6.0, though. 5.5 is probably more indicative of risk...

Posted by Anonymous on 23 June 2009

Thank god, I nearly died and certainly had my health ruined by the failure of the fasting glucose test to pick up my severe diabetes. For YEARS I was misdiagnoised, even when I went to the doc and told him to test me for diabetes all I got was the fasting test. I was very sick

Posted by dpillion on 23 June 2009

At long last.
The A1c test can be performed on non-fasting individuals, using a single drop of blood, in 5-7 minutes, for under $15.00.
Every physician's office should be thinking of testing "non-diabetic" patients with moderate risk of having undiagnosed diabetes on a regular basis.
It should be a useful tool at communiy health fairs as well, but in that setting, trained staff are needed to counsel patients and refer them into the health care system when abnormal results are found.

Posted by Anonymous on 26 June 2009

Can't agree with this one unless the cutoff was lower as one person already suggested, 5.5. A1c is an AVERAGE... a person could be having as many highs as lows and have a good A1c. That said I wonder how many people know that a fasting blood sugar test result could be lower if you have had a drink the evening before?

Posted by Melitta on 27 June 2009

A1c is not an appropriate method for diagnosing Type 1 diabetes. I don't know why these organizations are not specifying that this is appropriate only for diagnosing Type 2.

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