A1c soon to be ‘Betes main diagnostic tool
I was just thumbing through the most recent issue of JAMA (that would be the Journal of the American Medical Association….am I sounding smart yet?) and I was alerted that the new diagnostic criteria for diabetes will soon officially be the A1c test - this is a HUGE shift away from the traditional use of the fasting blood sugar test. Turns out, that test isn’t all that convenient, and could have been contributing to the large percentage of folks who have diabetes but have never never been diagnosed.
“Probably up to 40% of people with diabetes are undiagnosed, and one reason would be that the test used most to diagnose diabetes requires fasting” said Christopher Saudek, MD, who is a professor of Medicine at Johns Hopkins University. Having to fast for the test would mean any patient who came into his/her doctor’s office having already eaten would have to return for an additional test done after fasting. In addition, fasting may be more difficult for those who work multiple jobs, have childcare duties, or poor access to healthcare in the first place (what do all of those items point to? à Low socioeconomic status, which we all know, the worse your $$ situation, the higher the risk for Type 2 ‘betes).
Daniel Einhorn MD (who just so happens to be my doctor! Loves it!), Medical Director of the Scripps Whittier Diabetes Institute noted that one advantage of the A1c is that is can be done at any time of day, and won’t be thrown off by having a cold, eating, or any other day-time events, all of which would have sacrificed the integrity of a fasting A1c.
So what will the cutoff values be? What A1c will warrant the Dx of diabetes? Looks like this will remain in debate from both a clinical and societal point of view. Mayer B. Davidson, MD, a professor of medicine at Charles R. Drew University noted that “glucose impairment runs on a continuum, so where you draw the line to say this is a disease – it is arbitrary. In our society, If you have a diagnosis of diabetes, you have a problem with medical insurance, so I draw the line higher….”
Wow. So your doctor could have the potential to decide that an A1c of 6.9% does not warrant the diabetes diagnosis? But complications can start to occur at an A1c as low as 6.0%! Fortunately, there is a committee of experts and specialists in place that is working to nail down a number that will become the official recommendation for diagnosis of both diabetes and pre-diabetes. Right now 6.5% is looking like the magic number. Interesting that number is also the target A1c recommended by the American Association of Clinical Endocrinologists for prevention of complications.
Once the numbers are locked, the American Diabetes Association plans to adopt the A1c as their officially endorsed diagnostic tool. This is incredibly important because a majority of primary care physicians (who treat the glut of Type 2 diabetics in this country, not Endos), look to the ADA Treatment Algorithm as the definitive roadmap for diagnosis and treatment of diabetes. This could potentially result in MILLIONS of undiagnosed cases coming to light. Which begs the question: is our healthcare system, in particular the payer groups, prepared to handle that much chronic illness? Only time will tell. The most important highlight of this change in diagnosis though, is the fact the millions of people will now have the opportunity to stop the progression of Type 2 diabetes before it stops them, and a value high enough cannot be placed on that knowledge.
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Comments
Jocelyn you are on the right track, and a 4.5 A1c is something to be proud of! Although Native Americans are at higher risk for diabetes, you already have so much power in just knowing you are at risk and taking steps like you are already doing to prevent diabetes.
LOVE Evil Beet - Sasha is the funniest girl ever! Glad you found this site 
Keep on coming by and keep taking care of yourself!
I had that test in the fall and was a 4.5. I’m overweight, Native American and most of my brown relatives HAVE diabetes. I’m working on losing weight and making better food choices. I think I’ll go have the test done again in a month or two to see how I’m doing. I didn’t try very hard after the first test but lately, I do realize that I need to do take action before something does happen.
I found you thru Evil Beet (man, she cracks ME UP!) and was reluctant to start reading you because I am a bit freaked out about diabetes. If I don’t read about it, it’ll go away, right? LOL I’m so thankful you are here. I appreciate the information you share.