felinefan67
06-22-2008, 05:01 PM
I consider myself fairly intelligent (I'm a certified Elem. Teacher), however maybe some of you could put in your thoughts or interpretations on this article regarding the A1c results??
As I mentioned, my April A1c was 5.8. Some say that is high normal, some say in the pre-D range. My FBG since last fall (including ONE LAB test) have all been below 100. I had THREE readings in March/April of 102,101, and 102 for three straight weeks on my dad's home meter) All FBG before and since have been below 100 as my 2 hour after meals have been.
Based on the following article (and my numbers) am I a Pre-D at 5.8??? My doc has said no. The article says "no". BTW, I'm still trying to watch what I eat and exercise but have gotten sloppy lately where food is concerned. I always drink more alcohol and eat more of (anything) in the summer. I still avoid lots of things such as sugar soda, pizza, most fast foods, etc) but definitely my carb intake is higher than it was two months ago.
This article has two alternating views on the 5.8 (above/below)reading:
The American Diabetes Association recommends confirmation of an FPG level to diagnose diabetes (3). Requiring confirmation (not available in NHANES data) would decrease sensitivity and increase specificity. However, an A1C level of 5.8% is consistent with the results of a previous ROC analysis on the 1988–1994 NHANES III population utilizing an ion exchange HPLC A1C assay (normal 5.17 ± 0.45% [SD]) with diabetes also diagnosed by an FPG 126 mg/dl. They concluded that the best screening value lay between 1 and 2 SDs above the mean (7). The two NHANES studies relate A1C levels to the prevalence of diabetes. Two studies have related A1C levels to the incidence of diabetes. In 1,253 veterans aged 45–64 years, the 3-year incidence of diabetes (by self-report, FPG 126 mg/dl or A1C 7.0%) at baseline A1C levels of 5.5, 5.6–6.0, and 6.1–6.9% was 0.8, 2.5, and 7.8 per 100 person-years, respectively (8). In 2,820 French people aged 30–65 years whose baseline A1C levels were split into deciles, the 6-year incidence of diabetes (diabetes drugs or FPG 126 mg/dl) was 2.5, 5.0, and 10% in the upper three A1C deciles of 5.7, 5.8, and 5.8–7.1%, respectively (9).
Based on the results of these studies relating A1C levels to both prevalent and incident diabetes, an A1C value in a DCCT (Diabetes Control and Complications Trial)-standardized assay (10) of 5.8% could effectively serve to identify individuals in whom further investigations might be fruitful. Since fasting is not necessary for A1C measurements, this approach would markedly reduce the number of people required to return for a fasting test. Given the A1C result, both physicians and their patients might be more motivated to further explore the potential diagnosis of diabetes.
Alternatively, an argument can be made to utilize only A1C levels for the diagnosis of pre-diabetes/diabetes. The levels of glycemia that are associated with the microvascular complications of diabetes are generally agreed upon as appropriate diagnostic criteria (11). In both type 1 (12–14) and type 2 (15,16) diabetic patients, these complications did not develop or progress for 6–9 years when the average A1C level was kept at <7.0%. Supporting this relationship, when A1C levels in three large diabetic populations were divided into deciles, the mean value in the first decile, in which retinopathy increased, ranged from 6.7 to 7.5% (17). Regarding A1C levels and pre-diabetes, people in the DPP (Diabetes Prevention Program) (18) with values of 6.1–6.9% were twice as likely to progress to diabetes as those with lower values (19).
Thus, we propose that individuals with A1C levels measured in a DCCT-standardized assay of 6.0% are normal, 6.1–6.9% have pre-diabetes, and 7.0% have diabetes. Since metformin is recommended for those with type 2 diabetes (20) and in younger obese people with pre-diabetes (19), A1C levels should be confirmed in these patients. Alternatively, an A1C level of 5.8% could lead to a glucose measurement (an FPG or even an oral glucose tolerance test). In either approach, diabetes will be diagnosed in those at clear risk for microvascular complications. Those with pre-diabetes will be identified so that appropriate measures can be adopted to reduce their chances of developing diabetes.
CONCLUSIONS—
TOP
INTRODUCTION
RESEARCH DESIGN AND METHODS--
RESULTS--
CONCLUSIONS--
References
The American Diabetes Association recommends confirmation of an FPG level to diagnose diabetes (3). Requiring confirmation (not available in NHANES data) would decrease sensitivity and increase specificity. However, an A1C level of 5.8% is consistent with the results of a previous ROC analysis on the 1988–1994 NHANES III population utilizing an ion exchange HPLC A1C assay (normal 5.17 ± 0.45% [SD]) with diabetes also diagnosed by an FPG 126 mg/dl. They concluded that the best screening value lay between 1 and 2 SDs above the mean (7). The two NHANES studies relate A1C levels to the prevalence of diabetes. Two studies have related A1C levels to the incidence of diabetes. In 1,253 veterans aged 45–64 years, the 3-year incidence of diabetes (by self-report, FPG 126 mg/dl or A1C 7.0%) at baseline A1C levels of 5.5, 5.6–6.0, and 6.1–6.9% was 0.8, 2.5, and 7.8 per 100 person-years, respectively (8). In 2,820 French people aged 30–65 years whose baseline A1C levels were split into deciles, the 6-year incidence of diabetes (diabetes drugs or FPG 126 mg/dl) was 2.5, 5.0, and 10% in the upper three A1C deciles of 5.7, 5.8, and 5.8–7.1%, respectively (9).
Based on the results of these studies relating A1C levels to both prevalent and incident diabetes, an A1C value in a DCCT (Diabetes Control and Complications Trial)-standardized assay (10) of 5.8% could effectively serve to identify individuals in whom further investigations might be fruitful. Since fasting is not necessary for A1C measurements, this approach would markedly reduce the number of people required to return for a fasting test. Given the A1C result, both physicians and their patients might be more motivated to further explore the potential diagnosis of diabetes.
Alternatively, an argument can be made to utilize only A1C levels for the diagnosis of pre-diabetes/diabetes. The levels of glycemia that are associated with the microvascular complications of diabetes are generally agreed upon as appropriate diagnostic criteria (11). In both type 1 (12–14) and type 2 (15,16) diabetic patients, these complications did not develop or progress for 6–9 years when the average A1C level was kept at <7.0%. Supporting this relationship, when A1C levels in three large diabetic populations were divided into deciles, the mean value in the first decile, in which retinopathy increased, ranged from 6.7 to 7.5% (17). Regarding A1C levels and pre-diabetes, people in the DPP (Diabetes Prevention Program) (18) with values of 6.1–6.9% were twice as likely to progress to diabetes as those with lower values (19).
Thus, we propose that individuals with A1C levels measured in a DCCT-standardized assay of 6.0% are normal, 6.1–6.9% have pre-diabetes, and 7.0% have diabetes. Since metformin is recommended for those with type 2 diabetes (20) and in younger obese people with pre-diabetes (19), A1C levels should be confirmed in these patients. Alternatively, an A1C level of 5.8% could lead to a glucose measurement (an FPG or even an oral glucose tolerance test). In either approach, diabetes will be diagnosed in those at clear risk for microvascular complications. Those with pre-diabetes will be identified so that appropriate measures can be adopted to reduce their chances of developing diabetes.
As I mentioned, my April A1c was 5.8. Some say that is high normal, some say in the pre-D range. My FBG since last fall (including ONE LAB test) have all been below 100. I had THREE readings in March/April of 102,101, and 102 for three straight weeks on my dad's home meter) All FBG before and since have been below 100 as my 2 hour after meals have been.
Based on the following article (and my numbers) am I a Pre-D at 5.8??? My doc has said no. The article says "no". BTW, I'm still trying to watch what I eat and exercise but have gotten sloppy lately where food is concerned. I always drink more alcohol and eat more of (anything) in the summer. I still avoid lots of things such as sugar soda, pizza, most fast foods, etc) but definitely my carb intake is higher than it was two months ago.
This article has two alternating views on the 5.8 (above/below)reading:
The American Diabetes Association recommends confirmation of an FPG level to diagnose diabetes (3). Requiring confirmation (not available in NHANES data) would decrease sensitivity and increase specificity. However, an A1C level of 5.8% is consistent with the results of a previous ROC analysis on the 1988–1994 NHANES III population utilizing an ion exchange HPLC A1C assay (normal 5.17 ± 0.45% [SD]) with diabetes also diagnosed by an FPG 126 mg/dl. They concluded that the best screening value lay between 1 and 2 SDs above the mean (7). The two NHANES studies relate A1C levels to the prevalence of diabetes. Two studies have related A1C levels to the incidence of diabetes. In 1,253 veterans aged 45–64 years, the 3-year incidence of diabetes (by self-report, FPG 126 mg/dl or A1C 7.0%) at baseline A1C levels of 5.5, 5.6–6.0, and 6.1–6.9% was 0.8, 2.5, and 7.8 per 100 person-years, respectively (8). In 2,820 French people aged 30–65 years whose baseline A1C levels were split into deciles, the 6-year incidence of diabetes (diabetes drugs or FPG 126 mg/dl) was 2.5, 5.0, and 10% in the upper three A1C deciles of 5.7, 5.8, and 5.8–7.1%, respectively (9).
Based on the results of these studies relating A1C levels to both prevalent and incident diabetes, an A1C value in a DCCT (Diabetes Control and Complications Trial)-standardized assay (10) of 5.8% could effectively serve to identify individuals in whom further investigations might be fruitful. Since fasting is not necessary for A1C measurements, this approach would markedly reduce the number of people required to return for a fasting test. Given the A1C result, both physicians and their patients might be more motivated to further explore the potential diagnosis of diabetes.
Alternatively, an argument can be made to utilize only A1C levels for the diagnosis of pre-diabetes/diabetes. The levels of glycemia that are associated with the microvascular complications of diabetes are generally agreed upon as appropriate diagnostic criteria (11). In both type 1 (12–14) and type 2 (15,16) diabetic patients, these complications did not develop or progress for 6–9 years when the average A1C level was kept at <7.0%. Supporting this relationship, when A1C levels in three large diabetic populations were divided into deciles, the mean value in the first decile, in which retinopathy increased, ranged from 6.7 to 7.5% (17). Regarding A1C levels and pre-diabetes, people in the DPP (Diabetes Prevention Program) (18) with values of 6.1–6.9% were twice as likely to progress to diabetes as those with lower values (19).
Thus, we propose that individuals with A1C levels measured in a DCCT-standardized assay of 6.0% are normal, 6.1–6.9% have pre-diabetes, and 7.0% have diabetes. Since metformin is recommended for those with type 2 diabetes (20) and in younger obese people with pre-diabetes (19), A1C levels should be confirmed in these patients. Alternatively, an A1C level of 5.8% could lead to a glucose measurement (an FPG or even an oral glucose tolerance test). In either approach, diabetes will be diagnosed in those at clear risk for microvascular complications. Those with pre-diabetes will be identified so that appropriate measures can be adopted to reduce their chances of developing diabetes.
CONCLUSIONS—
TOP
INTRODUCTION
RESEARCH DESIGN AND METHODS--
RESULTS--
CONCLUSIONS--
References
The American Diabetes Association recommends confirmation of an FPG level to diagnose diabetes (3). Requiring confirmation (not available in NHANES data) would decrease sensitivity and increase specificity. However, an A1C level of 5.8% is consistent with the results of a previous ROC analysis on the 1988–1994 NHANES III population utilizing an ion exchange HPLC A1C assay (normal 5.17 ± 0.45% [SD]) with diabetes also diagnosed by an FPG 126 mg/dl. They concluded that the best screening value lay between 1 and 2 SDs above the mean (7). The two NHANES studies relate A1C levels to the prevalence of diabetes. Two studies have related A1C levels to the incidence of diabetes. In 1,253 veterans aged 45–64 years, the 3-year incidence of diabetes (by self-report, FPG 126 mg/dl or A1C 7.0%) at baseline A1C levels of 5.5, 5.6–6.0, and 6.1–6.9% was 0.8, 2.5, and 7.8 per 100 person-years, respectively (8). In 2,820 French people aged 30–65 years whose baseline A1C levels were split into deciles, the 6-year incidence of diabetes (diabetes drugs or FPG 126 mg/dl) was 2.5, 5.0, and 10% in the upper three A1C deciles of 5.7, 5.8, and 5.8–7.1%, respectively (9).
Based on the results of these studies relating A1C levels to both prevalent and incident diabetes, an A1C value in a DCCT (Diabetes Control and Complications Trial)-standardized assay (10) of 5.8% could effectively serve to identify individuals in whom further investigations might be fruitful. Since fasting is not necessary for A1C measurements, this approach would markedly reduce the number of people required to return for a fasting test. Given the A1C result, both physicians and their patients might be more motivated to further explore the potential diagnosis of diabetes.
Alternatively, an argument can be made to utilize only A1C levels for the diagnosis of pre-diabetes/diabetes. The levels of glycemia that are associated with the microvascular complications of diabetes are generally agreed upon as appropriate diagnostic criteria (11). In both type 1 (12–14) and type 2 (15,16) diabetic patients, these complications did not develop or progress for 6–9 years when the average A1C level was kept at <7.0%. Supporting this relationship, when A1C levels in three large diabetic populations were divided into deciles, the mean value in the first decile, in which retinopathy increased, ranged from 6.7 to 7.5% (17). Regarding A1C levels and pre-diabetes, people in the DPP (Diabetes Prevention Program) (18) with values of 6.1–6.9% were twice as likely to progress to diabetes as those with lower values (19).
Thus, we propose that individuals with A1C levels measured in a DCCT-standardized assay of 6.0% are normal, 6.1–6.9% have pre-diabetes, and 7.0% have diabetes. Since metformin is recommended for those with type 2 diabetes (20) and in younger obese people with pre-diabetes (19), A1C levels should be confirmed in these patients. Alternatively, an A1C level of 5.8% could lead to a glucose measurement (an FPG or even an oral glucose tolerance test). In either approach, diabetes will be diagnosed in those at clear risk for microvascular complications. Those with pre-diabetes will be identified so that appropriate measures can be adopted to reduce their chances of developing diabetes.