The A1C: A Better Way to Diagnose Pre-Diabetes?
A full third of adult Americans are pre-diabetic, and a third of those will develop type 2 diabetes before they're ten years older. Unfortunately, only about seven percent of them have been tested for pre-diabetes and warned of their condition; the rest are ignorant of the road they're on. By losing just 10 to 15 pounds, the whole group could cut their chances of getting type 2 by half. The problem is, how to alert them in time for them to stop their progression to type 2?
According to research by Ronald Ackermann, MD, MPH, of the Indiana University School of Medicine, the A1C test, which is commonly used to track blood sugar levels of those with diagnosed diabetes, might be just the ticket to diagnose the growing masses with pre-diabetes. The current test for pre-diabetes, the fasting plasma glucose (FPG) test, is a pain in the neck, requiring two visits to the doctor, the second one after an inconvenient overnight fast. But the A1C test, which measures a patient's average blood glucose level over the preceding two to three months, is a relative snap, requiring only one visit and no fasting.
Currently, a diagnosis of pre-diabetes requires an FPG concentration between 110 and 125 mg/dL. Among adults meeting that criterion, about a third develop type 2 diabetes within eight years. According to Dr. Ackermann's study of 1750 people, an A1C between 5.5% and 6.5% (the cut-off for full-blown diabetes) identifies adults with that same risk of developing type 2. An A1C of 5.7% or more identifies people with a risk for diabetes of 41.3 percent.
Five years ago, Dr. Ackermann reported that it would be cheaper to pay for diabetes prevention when patients are only 50 years old than it would to wait until they're 65 and probably in need of more expensive treatments. Recently, some health plans have agreed with that logic and begun paying for diabetes prevention programs. The catch is that in order to qualify for the programs, patients must have been formally diagnosed with pre-diabetes. Making the A1C a standard screening test for those with risk factors could make a huge difference in the lives of millions, preventing not only type 2 diabetes, but also cardiovascular disease.
American Journal of Preventive Medicine
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