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Super Advisor
Dennis1947
Total Posts: 813
Registered on: ‎10-31-2009

ADA's revised A1c Guidelines for Diagnosis

American Diabetes Association Revises Diabetes Guidelines
December 29, 2009 - The American Diabetes Association (ADA) revised clinical practice recommendations for diabetes diagnosis promote hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. The new recommendations are published December 29 in the January supplement of Diabetes Care.

"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease," Richard M. Bergenstal, MD, ADA president-elect of medicine & science, said in a news release. "Additionally, early detection can make an enormous difference in a person's quality of life. Unlike many chronic diseases, type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."

The A1c test, which measures average blood glucose levels for a period of up to 3 months, was previously used only to evaluate diabetic control with time. An A1c level of approximately 5% indicates the absence of diabetes, and according to the revised evidence-based guidelines, an A1c score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or higher indicates the presence of diabetes.
Contributor
acidrock23
Total Posts: 1,362
Registered on: ‎10-31-2009

ADA's revised A1c Guidelines for Diagnosis

I'm cured!!
Frequent Advisor
sunritef
Total Posts: 2,610
Registered on: ‎11-30-2009

ADA's revised A1c Guidelines for Diagnosis

You are cured.. of Type 2


You go to school to learn, not for a report card.
You use your meter to learn, not for a report card

Type 1 (LADA).. Novolog/Levemir

Adult onset T1
Super Advisor
Pam01
Total Posts: 2,241
Registered on: ‎11-02-2009

ADA's revised A1c Guidelines for Diagnosis

and I"m working my way to pre-diabetes!
Pam

Diagnosed Type 1 at age 16 months, over 45 years now
Minimed pump and cgm since July '09. Metformin (insulin resistance), levothyroxine(thyroid), losartan (BP)

I have traveled cross country, and to Canada, UK, Kenya, Mexico, Jamaica, Equador/Galapagos islands, and lived in Egypt for a year.
Super Advisor
Pam01
Total Posts: 2,241
Registered on: ‎11-02-2009

ADA's revised A1c Guidelines for Diagnosis

but seriously, in a way the reasoning makes perfect sense. It's easier to get non-fasting bloodwork and probably more accurate in the long run than a single reading.

My husband, in a fairly unique circumstance of having had a successful pancreas transplant over 10 years ago, has occasional highs (we've never caught it over 200). A single blood test might say put him back on insulin, yet overall his a1c is around 5.5
Pam

Diagnosed Type 1 at age 16 months, over 45 years now
Minimed pump and cgm since July '09. Metformin (insulin resistance), levothyroxine(thyroid), losartan (BP)

I have traveled cross country, and to Canada, UK, Kenya, Mexico, Jamaica, Equador/Galapagos islands, and lived in Egypt for a year.
Super Advisor
Pam01
Total Posts: 2,241
Registered on: ‎11-02-2009

ADA's revised A1c Guidelines for Diagnosis


An A1c level of approximately 5% indicates the absence of diabetes, and according to the revised evidence-based guidelines, an A1c score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or higher indicates the presence of diabetes.


I just came back to look this up after reading a little blurb in Parade Magazine about 2 sitcom actors having their bloodwork come back with an A1C of 5.6%. According to the chart in the article, anything under 6% was ideal (read: Non diabetic?) which surprised me. I gues their 5.6 was ok, but I'd question the recommended range of "under 6"
Pam

Diagnosed Type 1 at age 16 months, over 45 years now
Minimed pump and cgm since July '09. Metformin (insulin resistance), levothyroxine(thyroid), losartan (BP)

I have traveled cross country, and to Canada, UK, Kenya, Mexico, Jamaica, Equador/Galapagos islands, and lived in Egypt for a year.
Long Lost Member
n3qe-tim
Total Posts: 377
Registered on: ‎11-01-2009

ADA's revised A1c Guidelines for Diagnosis

This is great for diagnosing T2's... but makes me wonder if it will result in even more adult-onset T1's being misdiagnosed as T2's.

The fascination the medical community has with A1C's is astounding. My insurance company's health-promotion unit calls me every month, says that their computer shows my most recent A1C but doesn't show my A1C at diagnosis and that they need that to see how much my control is improving. I then try to explain that I was diagnosed in 1982 at age 14 by peeing and having the Testape turn jet black, all while I was drifting in and out of DKA coma. Sometimes the individual on the other end of the phone gets it, but the health-promotion scheme they have doesn't get it!
Contributor
acidrock23
Total Posts: 1,362
Registered on: ‎10-31-2009

ADA's revised A1c Guidelines for Diagnosis

I think that the medical industry likes this test because it is 'dialogue free' if you pass? I have had some docs express some concern about the frequency of lows but, as long as I say "I can feel them" I get a "pass" and they can just skip to the "do you have any questions?" part and "cha-ching" off to the next 99213. W/O an A1C, they'd have to look at the logs, make some sort of guess about what's going on, etc. which makes them uncomfortable?

I would guess that perhaps if doctors were 'performance managed', they'd want to look at their stable of diabetics' A1C results as a good benchmark? While I do have some concerns about my own efforts to beat the test (being lower at blood draws...heh heh heh...), I think that it is a pretty good benchmark for me, because I haven't had a lot of problems. I do wonder what my doc would do were I to turn up all jacked up all over the place?
(anon)
Total Posts: 0

ADA's revised A1c Guidelines for Diagnosis

n3qe-tim (1/3/2010)
This is great for diagnosing T2's... but makes me wonder if it will result in even more adult-onset T1's being misdiagnosed as T2's.




Why, or under what circumstances, would that happen?
Long Lost Member
still_young_at_heart
Total Posts: 351
Registered on: ‎11-02-2009

ADA's revised A1c Guidelines for Diagnosis

As most primary care docs simply do a "fasting" glucose and waive off anything under 120 as good enough, the use of an A1c will probably lead to more timely diagnosis of some Type 2s. But I would guess that "prediabetes" = "fine" for most primary docs. At most they may make a suggestion to take off a couple of pounds and walk a little more which means that lots of individuals with A1cs that many of us here consider in need of work will get no guidance on how to avoid complications. That is the case now but a more aggressive A1c target might get many individuals into treatment earlier.

Maurie

Maurie
Diagnosed T1 1/2007 at the age of 57
Pumping humalog with a Deltec Cozmo