[felinefan67]

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.

[xMenace]

What do you want, a diagnosis? Ok. I hereby diagnose you as pre-diabetic!

WTH does that mean anyway? What do you need to do? It's simple: eat well, exercise well, and see a doctopr annually. Either way the prescription is the same.

[felinefan67]

X, Yes maybe (although you needn't get sarcastic). Basically the medical profession seems to be all over the map on this "condition" and that kind of irritates me. Maybe by viewing myself as pre-D and eating better I will avoid something worse down the line, yet if I'm considered "normal" (right now) Do I really need to watch myself as much as I have been??

I mean, you wouldn't BELIVE the numbers of carbs I ate and drank per day before I saw that 102 reading and got my 5.8 A1c. I ate and drank whatever and whenever I wanted (for almost 40 years). IF those eating habits haven't really pushed me over the edge into pre-D land, then am I being obsessive about keeping my carbs below 150 when before I probably consumed upwards of 500 carbs per day with little to no change in my blood sugar??

Don't get me wrong, I have seen many benefits (lower FBS levels, weight loss, and little to no low blood sugar symptoms like the shaking, weakness, etc).

I guess I won't say "diagnose ME" but rather, what do members on this board consider me (or themselves for that matter, esp in regards to similiar readings as mine??) I just would like to know for curiosity's sake. X, you've made yourself clear, now I would like to hear (if anybody cares to) what they think.

Actually too, I'm debating whether or not to bug my Doctor for an OGTT test in the fall when I go for a physical. If she truly thinks I'm not Pre-D, she may not agree to having me take the test. Then what?? New doctor? Trust her wisdom??

Again, only my doctor or A doctor can really truly diagnose me as Pre-D, or D, or whatever, but I'm still interested in other opinions.

[BlueSky]

Originally Posted by felinefan67

... I'm debating whether or not to bug my Doctor for an OGTT test in the fall when I go for a physical. ....

You could also ask your doctor to test your insulin level. It would show how insulin resistant you are, regardless of blood sugar levels. Bear in mind that blood sugar going up is just a symptom. By the time it starts happening, insulin resistance has been gathering momentum for many years. So all that 500 carb-a-day eating before your BG started going up did have an effect, even if you weren't aware of it.

[fgummett]

YOU: April A1c was 5.8%

ADA: 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.

YOU: you wouldn't BELIEVE the numbers of carbs I ate and drank per day before I saw that 102mg/dl reading and got my 5.8% A1c.

Yes I would because that means your BS regulation is currently working unassisted... But, I would still go with BlueSky's advice about the insulin level and consider sticking with healthy choices as you do already have D in the family.

[Ronin]

Hi Felinefan!

I've often posted the results of my personal research into the diagnosis of Pre-Diabetic. It is a new diagnosis that, to a large extent, is producing the results of the law of unintend consequences. The intent was to capture young people before Type-2 diabetes actually hit.

What has happened is that the adult population, in particular the over-50 crowd, has been the primary recipient of this diagnosis. So, more adults are getting the wake-up-call than children. This could be because more adults get regular BG testing, or the test doesn't show up as easily in children.

The fact is that there is some proof that long before diabetic complications set in (neuropathy, retinopathy, et cetera) there were markers that could have been used to get people to do something before if they had been diagnosed as a result of showing the initial signs of complications.

If you and your MD agree that you are Pre-Diabetic that's fine. If you decide for yourself that you have taken the warning and you are a self declared Pre-D that is also fine. What is not fine is ignoring all of this and allowing your body to degrade to the point where the complications set in.

Keep in mind that a lot of the levels and values that the ADA uses have been primarily for Type-1 diabetics and the technology like pumps and micro-dosing of insulin are new so the values that are considered good for an insulin dependent diabetic may not be so good for a person who doesn't actually have diabetes -- yet.

I have to second Blue Sky's recommendation to get your insulin levels checked. The presumption that all adult onset cases of rising BG levels are automatically Type-2's is bogus. I know that there are a lot of people just like me that have low insulin levels and rising BG testing, despite diet and exercise modification.

There have been studies that show that non-diabetic people have HbA1c values that are generally <5.0. So, while 5.8 might not be a diagnostic level, it is a warning that something isn't right.

[felinefan67]

I guess one of the things I can take from this discussion is that even though I might be lucky so far and not even be a pre-D, I still need to make changes because my Dad is now a type 2 and I am in that 40+, overweight, sedentary, group (although I've been working hard to change that).

I think secretly I am hoping by some miracle I can still eat what I what and drink what I want. Although I am grateful that my mother forbid sugar sodas in the house when I was growing up. She never bought them. We also never kept candy bars either. We did have the old "Borden" gallon plastic pails of ice cream though and boy, my brother and I used to make quite a dent in them nightly during the summer

I think I will try and settle this issue with my Doctor in the fall. I will plead my case for additional testing (OGTT, insulin test, etc) and hope she indulges me. If I pass all the tests with flying colors and am considered "normal" non-pre-D, then I guess I will relax SOME but continue healthy eating and exercising because I like the weight loss and I feel better all the way around!

[felinefan67]

Oh, also, one more thing:

Bear in mind that blood sugar going up is just a symptom.

I'm still not 100% sure my blood sugar HAS gone up! Up until 2003 FBG < 110 was considered normal. Even with the lowering of that number to 99, I tested as a 99 at the lab last Fall. It's only with my dad's meter a few times that my FBG was 102. My doctor would probably discount those readings and go with last year's lab results (normal) and this year's numbers (which will most likely test well within normal range) and therefore she will declare me as perfectly normal. AND, who knows? I've only been tested for a bit over a year. How many years PRIOR, have I had FBG readings a bit over 100 and never was aware of it?? did that make me pre-D then? and did I slip between "normal" and "Pre-D" for years? I will still have my dad's meter readings haunting me forever as to whether or not they were really accurate or if the meter was off those few weeks and I really was below 100 all along. I guess I have to pay attention to the A1C of 5.8 and the lab readings to determine my status. Regardless, I've changed my lifestyle for the better forever, I hope!

Thanks for all the information and thoughts. This all helps me sort out my thinking.

[Funnygrl]

Pre-diabetes can only be diagnosed based on fasting readings. Your lab valued fasting readings are below 100. Your a1c is normal. You're not pre-diabetic. You're normal. I wouldn't worry.

[PERKDOUG]

Response to FelineFan:

You might do what I have done. Purchase a cheap Walgreen Blood glucose meter and do your own oral g. tolerance test.

Go to Jenny's site at:

What is a Normal Blood Sugar?

There you can see how to do the test. You can also test various meals for glycemic response and refine your food selections. This gives peace of mind. I have done dozens of tests and removed many foods from my diet.