Description

Dr. Mona explains the A1C test and why experts are saying it should now be the main tool doctors use to diagnose diabetes.

Transcript

Dr. Mona Khanna: An international community of experts has called for one type of blood test to become that new standard method for diagnosing Type 2 diabetes. The test is called a hemoglobin A1c assay. It would replace the common blood glucose tests that are currently used to diagnose Type 2 diabetes. The hemoglobin A1c assay has been available for years, but is currently used to monitor how well the patient who has diabetes is keeping the blood glucose under control. This new recommendation will change the use of that test from monitoring to diagnosing. Experts recommend that a patient with hemoglobin A1c of 6.5% or higher, be diagnosed with Type 2 diabetes. Patients with a hemoglobin A1c between 6% and 6.5% should be considered as highest risk of developing this type of diabetes, prediabetes and receive the appropriate interventions said the committee. There is no hard in fast line between prediabetes and a normal reading. Your practitioner will probably take your other medical conditions into consideration when making the diagnosis. Question: Who is making these recommendations? Dr. Mona Khanna: The groups that are commending this change are international and influential decision makers, who are grounded in science and medicine. They consist of patient, consumers, health professionals and scientists. They represent more than 200 national diabetes associations in almost 200 countries. The Umbrella policy making organizations to which they belong are the American Diabetes Association, the European association for the study of diabetes and the international diabetes federation. So the recommendations are considered very seriously by medical practitioners. However, the ultimate decision of how each practitioner will test his/her own patients for diabetes is an individual one. Question: How will these recommendations affect me? Dr. Mona Khanna: If you have already been diagnosed with Type 2 diabetes, it won't affect you. The test will replace the daily blood sugar checks that your doctor wants you to do at home and you will still get your hemoglobin A1c test once or twice a year like you usually do to see how well you are doing in keeping your blood glucose under control. Question: How and why was this test chosen? Dr. Mona Khanna: In the past, the hemoglobin A1c assay has primarily been used to monitor how well a patient who has diabetes is keeping his/her blood sugar under control. Experts want to now use it as the primary test for diagnosis of Type 2 diabetes, because it has less variation than blood glucose. It is easier and more convenient since it doesn't require fasting. It also better protects the risk for longterm complications like nerve pain and kidney damage. In fact, the cut off numbers like 6.5% are based on research showing that the higher hemoglobin A1c's are linked to retinopathy, which is diabetes associated deterioration of the eye. By the way, this test does not replace the daily blood sugar checks that your doctor wants you to do at home. Question: What does hemoglobin A1c mean? Dr. Mona Khanna: Hemoglobin A1c is reported as a percentage of the total amount of hemoglobin in the blood. That's why a normal non-diabetes level is measured in the percentage of less than 6.5%. Hemoglobin molecules contain iron and they also carry oxygen to your body cell. Glucose molecules stick to the hemoglobin at the same percentage that they are present in the blood. So, the more glucose is in the blood stream the more sticks to the hemoglobin molecule. That's why a blood sample that checks for the amount of glucose that is stuck to the molecule of hemoglobin is a good indicator of how much extra glucose you have in your blood because the life of the hemoglobin molecule is only two to three months. The reading is going to be reflexion of the glucose level over several weeks. If you have a hemoglobin A1c of 6.5% or higher, you probably will be diagnosed with diabetes. Patients with hemoglobin A1c is between 6 and 6.5% are at the highest risk of developing diabetes. It's important to recognize the different labs that may have different reference ranges, although the 6% and 6.5% values are pretty typical. Question: What is today's current method of diagnosing Type 2 diabetes? Dr. Mona Khanna: Right now, an ordered to be diagnosed with Type 2 diabetes, you are usually tested in one of three ways. The first test is called the fasting plasma glucose. It measures blood glucose in a person, who has not eaten any thing for at least 8 hours. The second test is called the oral glucose tolerance test. It measures blood glucose after a person fasts at least 8 hours then drinks the glucose beverage and then has the blood glucose rechecked two hours later. The third test is the random plasma glucose test. It measures blood glucose at anytime without even considering when the last meal took place. If these tests indicate the possibility of diabetes, they should be redone on another day for confirmation. Question: Does this mean I can stop checking my blood sugar every day? Dr. Mona Khanna: Hemoglobin A1c is an important test for diagnosing and monitoring diabetes, but it doesn't replace your own daily testing of blood glucose, because these checks measure day-to-day control. They are also necessary for adjusting your insulin dosage. Other Changes Dr. Mona Khanna: Now that the hemoglobin A1c assay has been recommended as a standard test. The diabetes panel goes one step further and says that all adult patients who are overweight and have other risk factors such as a family history of diabetes, high blood pressure or abnormal lipids, should have their hemoglobin A1c tested.