How exactly are people definitively diagnosed

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beachgirl Posted: Thu, Aug 20 2009 6:21 PM

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Hi, after reading numerous posts....people out there with great A1cs have been diagnosed? What is the bottom line...sorry, but I am getting so confused.

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Ron AKA replied on Sat, Aug 22 2009 12:16 PM

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Diagnosis is not made with the A1C, but either the fasting BG or the OGTT (two hours after 75 grams of glucose in a drink). See these charts and this link. In the yellow is pre-diabetes, and in the red is full diabetes:

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Joe replied on Sat, Aug 22 2009 9:32 PM

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beachgirl:

Hi, after reading numerous posts....people out there with great A1cs have been diagnosed? What is the bottom line...sorry, but I am getting so confused.

My A1C at diagnosis was 6.9% -- my FBG was 167.  The diagnosis was made based on successive FBG readings that were above the cutoff and not the A1C.

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mrfino replied on Sun, Aug 23 2009 10:11 PM

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A1C has recently been touted as a way to diagnose diabetes: http://www.medscape.com/viewarticle/704021.

John

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shortie replied on Mon, Aug 24 2009 10:01 PM

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I was just going to post that info also!!!!   It was on the World News one night about 2 months ago and then also was in Diabetes Forecast magazine.  I have said that Ha1C should be the correct way to test for diabetes, remember my husband has a fasting normal number but a 5.9 Halc.  He has had a stroke 8 years ago.

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jen1229 replied on Tue, Aug 25 2009 12:15 AM

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Forgive me if I'm being obtuse here, but isn't a 5.9 in the normal range?  have they lowered it again?

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Ron AKA replied on Tue, Aug 25 2009 8:55 AM

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I've never seen any official numbers for "normal" as to my knowledge there is no official diagnosis criteria based on the A1C. To date it has just been used to monitor the control a diabetic has of their blood sugar. My guess would be that a non diabetic will be in the mid 4's to 5, but is just a guess. 6 would be at the upper end of normal. There was the controversial Accord Trial which compared Type 2's targeting to be under 6 to those targeting to be between 7 and 7.9. The trial was stopped because they found an unacceptably higher death rate in the study group targeting to be under 6. I still target to be under 6, but do not do anything rash to get there.

I don't agree with using the A1C for diagnosis for a few reasons:

1. The test is still not standardized in all labs, so you can't always compare results from one lab to another or to a fixed standard.

2. The test is an average, and can be insensitive to someone who is having highs and lows, where they average out to what looks good, but it really is not.

3. Studies have found that there is a significant variation from individual to individual on how high BG translates to high A1C. So some individuals could have high BG but their A1C looks good. The A1C test would miss these individuals.

I think if there is a problem with our current diagnosis method in North America, it is the infrequent use of the OGTT. I suspect many diabetics are slipping through the cracks because they only get a fasting test. The result is that the condition can go on for a long time with complications (CVD) developing, before they are finally diagnosed.

Don't think there is any harm in getting an A1C, as long as you are careful with the results. A 9.0 almost certainly means there is a problem. A 5.9 probably tells you nothing. While it may be slightly higher than one would like to see in a non diabetic, it could be the test method, individual variation, or that diabetes is masked due to high low averaging. You really need a fasting and OGTT to know for sure.

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shortie replied on Mon, Aug 31 2009 10:46 AM

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I wish I had known enough about diabetes to have asked for a Ha1C back when I had my blood taken for Fasting Blood Glucose....it was 154........but I did not know I was diabetic till my appt.  I had an infection in my eye and that is what brought me to a doctor after about 19 years of not going to one!  Live and learn.  I think both should be taken if the doctor suspects diabetes!  That would give the whole picture.

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Madman replied on Mon, Aug 31 2009 12:53 PM

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Standard finger stick test should be done at each doctors visit.  If the blood sugar is elevate, a follow up test should be ordered/performed.  The cost of a standard finger stick test is about $1.  This would not signifcantly add to the cost of a dr's visit.

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Joe replied on Wed, Sep 2 2009 8:18 AM

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beachgirl:

Hi, after reading numerous posts....people out there with great A1cs have been diagnosed? What is the bottom line...sorry, but I am getting so confused.

A couple of interesting places to check:

http://www.phlaunt.com/diabetes/16422495.php

http://www.phlaunt.com/diabetes/14046782.php

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beachgirl replied on Wed, Sep 2 2009 8:39 AM

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Yikes....I am well into the worrisome numbers posted on these sites, but it does help to confirm my thought that the OGTT should have a one hour check...I will try to advocate for that tomm at my appt.