a doctor says

I n today’s Guardian, Doctors write of their own choices when faced with various illnesses. On diabetes, this doctor said:

“I would never take medicines to lower my blood sugar for a haemoglobin A1c of 7%. A long-term study of 50,000 diabetics in the UK found that trying to lower A1cs below 7.5% increases the overall death rate. I’m not sure we should even call an A1c of 7% “diabetes”, but I’m very sure I wouldn’t take medicines to lower it. Instead, I would try to lose weight and exercise more – and would be open to considering medications to lower blood pressure and cholesterol.”

and

The haemoglobin A1c test is a better indicator of diabetes risk than the commonly used measure of fasting glucose .

Recent research by the Johns Hopkins Bloomberg School of Public Health has suggested that measurements of haemoglobin A1c (HbA1c) more accurately identify individuals at risk of diabetes than the commonly used measurement of fasting glucose.

“HbA1c has significant advantages over fasting glucose,” stated Elizabeth Selvin, the study leader.

The A1c test has low variability on a daily basis and levels are not as affected by illness andstress . It is more stable and the patient does not need to fast prior to the test being performed.

This study has been published just as a major change in the way doctors diagnose diabetes is underway. In January, the American Diabetes Association (ADA) published amended recommendations for diabetes screening and diagnosis .

 

These 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, also known as “pre-diabetes.”

These new findings are of great help to doctors and patients in the interpretation of HbA1c test results.

In the study, people with HbA1c levels between 5.0 to 5.5 percent were identified as being in the “normal” range.

Most of the American population is within this range. The study discovered that with each incremental HbA1c rise, the incidence of diabetes went up too; those at a level of 6.5 percent or greater are considered diabetic , and those between 6.0 and 6.5 percent 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 percent as “at very high risk” of developing diabetes within 5 years.

The range of 5.5 to 6 percent, according to the ADA guidelines, is the appropriate level to initiate preventive measures.

My readings in April and December were 5.9 and 6.

The study appears in the New England Journal of Medicine, March 4, 2010.

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