The A1C: A Better Way to Diagnose Pre-Diabetes?

Fairbanks Hall, headquarters of the Indiana University School of Medicine

| Jan 10, 2011

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. 

Sources:

EurekAlert

American Journal of Preventive Medicine

 

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Categories: A1c Test, Blood Glucose, Blood Sugar, Diabetes, Diabetes, Health Care, Pre-Diabetes, Type 2 Issues


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Comments

Posted by bsc on 12 January 2011

I am really surprised at this article. The A1c is not better than the fasting blood sugar at diagnosing diabetes, they are both "lousy" catching diabetes late in the progression. If your A1c or fasting glucose has gotten bad enough to become prediabetic, then you can forget about catching things early, you have diabetes.

If you really want to get on top of your diabetes early, test for impaired fasting glucose. That is the conclusion of the WHO and it is by far the most sensitive test. In fact, the ADA has just recommended that all pregnant women be screened for diabetes using a glucose tolerance test, exactly the test that would indicate impaired fasting glucose. Even the experts, the American Association of Clinical Endochronologists disagree with the use of the A1c as a basis for diagnosis. Take heed, if you want to catch your diabetes early and have a chance of managing your condition with just diet and exercise, don't use the A1c for diagnosis.

On the other hand, if you want to visit your doctor every twenty years, pay almost nothing for the visit and don't really care about your health, then the A1c may not be that bad.

Posted by bsc on 12 January 2011

Well I mixed up impaired fasting glucose tolerance and impaired glucose tolerance in my comment, my apologies. The WHO recommends the impaired glucose tolerance. Any suggestion that an A1c is better than a blood sugar meter because you get an instant test seems strange. Blood sugar meters are widely available. To test impaired glucose tolerance, feed your patient a can of soda when they get to the office, the test them when in the window 30 minutes to two hours after ingestion. If they test over 140 mg/dl, you should be concerned about diabetes.

Posted by bsc on 12 January 2011

Well I mixed up impaired fasting glucose tolerance and impaired glucose tolerance in my comment, my apologies. The WHO recommends the impaired glucose tolerance. Any suggestion that an A1c is better than a blood sugar meter because you get an instant test seems strange. Blood sugar meters are widely available. To test impaired glucose tolerance, feed your patient a can of soda when they get to the office, the test them when in the window 30 minutes to two hours after ingestion. If they test over 140 mg/dl, you should be concerned about diabetes.

Posted by Anonymous on 12 January 2011

BSC's comment above seems tragically wide of the mark.
Prediabetes can be diagnosed with an elevated A1C level, BEFORE it is too late. The ADA guidelines state that A1C of 5.7 to 6.4 indicates prediabetes. The test is MUCH less of a hassle than the nausea inducing and time consuming glucose tolerance test. And less hassle means more people tested and helped sooner.

Posted by Anonymous on 13 January 2011

Wow. such low A1-Cs. Being below 7 seems great to a parent of a child with type one!

Posted by Anonymous on 23 January 2011

I have recently learned of "pre-diabetes" and immediately was successful in dropping 20lbs. But then a friend donated a glucose test kit to my cause and I started to keep track of my glucose levels in the AM. It is rarely below 100, but rarely above 115 over 45-70 days.
But it is rarely over 125 2 hours after eating!
I am researching why this should be and have been unsuccessful on finding an answer, or consensus at what levels prediabetes exists or whether I need to be concerned. Ugh!

Posted by Anonymous on 30 January 2011

Well, in 1991, before the diagnostic cut-offs changed, I had a FBG of 138 in June and 131 in September. Clearly diagnosable by today's standards. BUT my A1c two months later was 4.8, CLEARLY non-diabetic. So which do I believe? The use of the A1c test ignores the fact that different people have different rates of glycation, and while it will catch the high glycators, it will definitely miss the low-glycators. This would be OK if low glycation meant low risk of complications, but that has never been proven. I think relying on the A1c is a HUGE mistake.


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