A1C better at diagnosing...

March 22, 2010

Issue 513

A1c Outperforms Fasting Glucose for Diabetes Risk Prediction

Measurements of hemoglobin A1c (HbA1c) more accurately identify persons at

risk for clinical outcomes than the commonly used measurement of fasting

glucose,

according to a new published study.

HbA1c levels accurately predict future diabetes, and they better predict

stroke, heart disease, and all-cause mortality as well.

Lead author Selvin, PhD, s Hopkins Bloomberg School of Public

Health, Baltimore, MD, stated that, as a diagnostic, " Hb A1c has significant

advantages over fasting glucose. " The A1c test has low variability from day

to day, levels are not as affected by stress and illness, it has greater

stability,

and the patient is not required to fast before the test is performed.

This study is published on the heels of a major change in the way doctors

diagnose diabetes. In January, the American Diabetes Association (ADA)

published

revised recommendations for the screening and diagnosis of diabetes. The

revised recommendations include, for the first time, recommendations to use

HbA1c

to diagnose diabetes and also to identify people at risk of developing

diabetes in the future.

The new findings can help doctors and patients interpret HbA1c test results.

In the study, people with HbA1c levels between 5.0% to 5.5% were identified

as being within " normal " range. The majority of the U.S. adult population is

within this range. With each incremental HbA1c increase, the study found,

the incidence of diabetes increased as well; those at a level of 6.5% or

greater are considered diabetic, and those between 6.0% and 6.5% are

considered

at a " very high risk " (9 times greater than those at the " normal " range) for

developing diabetes.

The revised ADA guidelines classify people with HbA1c levels in the range of

5.7% to 6.4% as " at very high risk " for developing diabetes over 5 years.

The

range of 5.5% to 6%, according to the ADA guidelines, is the appropriate

level to initiate preventive measures.

The study measured HbA1c in blood samples from more than 11,000 people,

black and white adults, who had no history of diabetes. The samples were

obtained

between 1990 and 1992 as part of the Atherosclerosis Risk in Communities

(ARIC) Study at four ARIC field centres in Hagerstown, MD. The samples have

been

in cold storage since their collection. " It is amazing to be able to use

blood samples collected over a decade ago, " said Dr. Selvin, because

researchers

were able to look at participants' measurements and compare to outcomes that

occurred during 15 years of follow-up.

NEJM, March 4, 2010

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