[Caravaggio]

I just read today the AACE/ACE statement on the use of A1c for the diagnosis of diabetes. This is the link.

http://www.aace.com/pub/pdf/guidelin...A1cfeb2010.pdf

[fgummett]

Thanks for posting this reality check

AACE/ACE
STATEMENT ON THE USE OF A1C FOR THE DIAGNOSIS OF DIABETES

February 2010— The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have evaluated the role of A1c for the diagnosis of type 2 diabetes (diabetes). The American Diabetes Association (ADA) 2010 Clinical Practice Recommendations endorse the use of A1c of 6.5% or higher as the primary criterion for the diagnosis of diabetes.

The rationale for the use of A1c for diagnosis is based on data showing that retinopathy occurs in individuals with an A1c ≥6.5% at approximately the same rate as in individuals who are diagnosed based on the current fasting and post-challenge glucose criteria. A 10% risk for retinopathy has historically served as the bench mark for diagnosing the presence of diabetes.

The use of A1c for the diagnosis of diabetes has several advantages. It does not require the patient to be fasting, can be done at any time that a visit is scheduled, is simpler to perform than the 2 hr oral glucose test, and is less dependent on the patient’s health status at the moment of the blood draw. However, use of A1c ≥6.5% identifies approximately 20% fewer people with diabetes than do existing criteria based on fasting plasma glucose and oral glucose tolerance tests.

AACE/ACE support the ADA recommendations for use of a confirmed A1c as an available option to diagnose diabetes, with the following recommendations:

1. A1c should be considered as an additional optional criterion, not as the primary criterion.
2. AACE/ACE suggest using traditional glucose criteria for diagnosis when feasible.
3. A1c is not recommended for diagnosing type 1 diabetes.
4. A1c is not recommended for diagnosing gestational diabetes.
5. A1c may be misleading in several ethnic populations (e.g. African-Americans).
6. A1c may be misleading in the setting of various hemoglobinopathies, iron deficiency, hemolytic anemias, thalassemias, spherocytosis, and severe hepatic and renal disease.
7. AACE/ACE endorse using only standardized, validated assays for A1C testing.

AACE/ACE do not endorse A1c criteria for pre-diabetes or for those at risk for diabetes. AACE/ACE do support an A1c of 5.5-6.4% as a screening test for pre-diabetes if it leads to measurement of fasting glucose or a glucose tolerance test for diagnosis.

The AACE/ACE position statement is based on available data as of February 2010 and may be amended as new data become available.

1 Diabetes Care, January 2010, Vol. 33:Supplement 1; doi:10.2337
2 Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey; 2005-2006 (NHANES)

[fgummett]

The Canadian Diabetes Association, 2008 Clinical Practice Guidelines states...

Although the frequency distributions of glycated hemoglobin (A1C) levels in some studies have characteristics similar to those obtained from FPG and 2hPG tests, the lack of standardization of the A1C test precludes its use in the diagnosis of diabetes.

[foxl]

Sigh.

I really do not like that reference to convenience.

Nor to 100% retinopathy.

[ljjhouser]

Thanks - Good information. I am wondering what the fasting blood glucose testing criteria used for diagnoses is. Thanks, Larry

[foxl]

Originally Posted by foxl

Sigh.

I really do not like that reference to convenience.

Nor to 100% retinopathy.

D'OH! 10% retinopathy. Nonetheless ... why wait till it comes to that?

[fgummett]

Originally Posted by foxl

D'OH! 10% retinopathy. Nonetheless ... why wait till it comes to that?

Because for some reason the focus (pun intended!) appears to be on "treating" disease rather than "preventing" disease... can't very well treat a "lack of retinopathy" now can you

As for "the convenience" it sounds too much like a rationalisation to me... it's bad enough having D without subjecting the poor dears to fasting tests... and as for pricking their fingers every day

It may be a [minor] inconvenience but if it helps me to live a long and healthy life well guess what option I would choose.

You know what... I find brushing my teeth after each meal REALLY inconvenient... can I maybe just do it every 3 months at a time of day that suits me

[foxl]

Without using a ditto sign, Frank, I must say I wholeheartedly agree and simply have nothing to add

(but wanted to outwit the minimum post, too).

[zoelula]

I'm confused. I knew they were recommending switching to A1C as the standard of diagnosis but I had thought they proposed the cutoff as 6.0 not 6.5.

[foxl]

"AACE/ACE do support an A1c of 5.5-6.4% as a screening test for pre-diabetes if it leads to measurement of fasting glucose or a glucose tolerance test for diagnosis."

So they do not expect Internists to use BOTH FBG AND A1c in their preliminary physical???

"However, use of A1c ≥6.5% identifies approximately 20% fewer people with diabetes than do existing criteria based on fasting plasma glucose and oral glucose tolerance tests."

Hello, folks, IMHO they are ALREADY MISSING people ... and now they are gonna overlook one in FIVE, when we have an epidemic???

[cyberus]

Interesting.

I've personally never had an OGTT but my docs office does my quarterly bloodwork (which includes both BG and a1c) as fasting tests so I guess I got a good doc

[fgummett]

Originally Posted by cyberus

I've personally never had an OGTT but my docs office does my quarterly bloodwork (which includes both BG and a1c) as fasting tests so I guess I got a good doc

I suspect that your initial A1c of 10.6% was sufficient to indicate diagnosis... I think the concern is for those who may have a "normal" A1c and/or Fasting BG and slip through the net... even though they could still be Glucose Intolerant.