![]() Bloomgarden argued that it would be inappropriate to use A1c as a standard for the entire population, especially when people with diabetes have high rates of anemia and kidney failure. Factors that can interfere with this relationship include certain genetic variations, race, age, and certain disease states such as kidney failure or anemia (iron deficiency). In particular, he noted that individual differences can alter how A1c correlates with average blood sugar. Bloomgarden, however, questioned the relationship between blood sugar and A1c. Nathan argued that current methodology allows for much more consistent and accurate measurements than what was available in 2003.ĭr. An expert committee found in 2003 that the A1c test was not yet accurate enough for clinical diagnosis, but Dr. Nathan made the case that A1c has not been included as a standard test because the early laboratory methods for measuring it were inaccurate. ![]() Because of this, doctors can be confident that a patient’s A1c has not been influenced by arbitrary short-term factors.ĭr. FPG and OGTT, on the other hand, are sensitive to factors such as stress and forgetting to fast. Potentially most importantly, A1c levels do not vary drastically from day to day in a person. His main argument was that A1c better indicates a person’s long-term exposure to high blood glucose than either fasting glucose or glucose tolerance. In his talk, he defended the use of A1c for both diagnosis and long-term monitoring of diabetes. David Nathan, a member of the authoring committee for this document. Possibly one of the most highly talked about sessions at the 2009 ADA Scientific Sessions was given by Dr. Diabetes was defined by an A1c of over 6.5%, and those with an A1c between 6.0% and 6.5% were termed an “at risk” population. In mid-2009, a committee of diabetes experts from around the world jointly produced a series of guidelines for diagnosing diabetes using the A1c test. Zachary Bloomgarden, summed up the many talks that were given on the A1c test at the 2009 American Diabetes Association (ADA) Scientific Sessions (for our coverage of this meeting, see Conference Pearls from diaTribe #16). In the December issue of the scientific journal Diabetes Care, Dr. There has been a great deal of debate on how to interpret and express A1c results, however. The test is simpler for patients (no fasting or ingestion of glucose is necessary), and its results are more consistent than either FPG or OGTT. So, when your blood sugar is consistently high, it is reflected by a higher than normal A1c. ![]() In short, the A1c test allows physicians to approximate a person’s average blood glucose over the past three months. We gave an in depth explanation of the A1c test in an earlier Learning Curve. One of the more controversial issues in diabetes today is the use of the A1c test to diagnose diabetes instead of the current standards of fasting plasma glucose (FPG – measures blood glucose after a 12-14 hour fast) or oral glucose tolerance tests (OGTT – blood glucose is measured after the patient consumes a standardized amount of glucose).
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