# A!c of 6.5 as dx criteria for T2



## Peter C (Feb 21, 2010)

Don't know if this addition to diagnostic criterion has been mentioned already ...
February  2010? The American Association  of Clinical  Endocrinologists  (AACE)  and  the  American 
College of Endocrinology (ACE) have evaluated the role of A1c for the diagnosis of type 2 diabetes 
(diabetes).  The  American  Diabetes  Association  (ADA)  2010  Clinical  Practice  Recommendations 
endorse the use of A1c of 6.5% or higher as the primary criterion for the diagnosis of diabetes. 
The rationale  for the use of A1c  for diagnosis  is based on data showing  that retinopathy occurs  in 
individuals with an A1c ≥6.5% at approximately the same rate as  in  individuals who are diagnosed 
based  on  the  current  fasting  and  post-challenge  glucose  criteria.  A  10%  risk  for  retinopathy  has 
historically served as the bench mark for diagnosing the presence of diabetes. 
The use of A1c for the diagnosis of diabetes has several advantages. It does not require the patient 
to be fasting, can be done at any time that a visit is scheduled, is simpler to perform than the 2 hr 
oral glucose test, and  is  less dependent on the patient?s health status at the moment of the blood 
draw. However, use of A1c ≥6.5% identifies approximately 20% fewer people with diabetes than do 
existing criteria based on fasting plasma glucose and oral glucose tolerance tests.


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## Tezzz (Feb 21, 2010)

Interesting stuff Peter. Thank you for sharing it with us. I'll pass that on to my doctor who has a specific interest in diabetes.


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## wallycorker (Feb 21, 2010)

Yes - I had heard from somewhere that HbA1c is starting to be used as a diagnostic tool in the US.

Personally, I was diagnosed with a fasting blood glucose just over 7 mmol/l and an HbA1c in the 5s. It took quite a long time for the latter to rise as high as 6.5%. As a result, this latest move in the US would have put my Type 2 diagnosis off by several years. I suppose this sort of thing is all about massaging numbers to keep them down and to put off dealing with the difficult problems that it creates for healthcare professionals and politicians.

With the benefit of hindsight, even though I was diagnosed at an early stage, I now suspect that the development of my diabetic condition could have been foreseen many years earlier. At a time when my blood pressure changed from being always low to very suddenly being high. At the same time my cholesterol was found to be very high at 9.7 this being in the early days of cholesterol checking.

When are the powers that be going to accept that the sooner that people start dealing with a Type 2 diabetic situation by quite simply adjusting the diet then the sooner all the figures will start to improve and at the same time save the health authorities millions? Putting the problem off to be dealt with at a later date quite simply makes the situation worse and harder to deal with - in addition, it causes misery to many of the people affected.

In my opinion, action is needed sooner rather than later!

John


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## HelenM (Mar 2, 2010)

I don't think this is about massaging the figures, the cost of the testing will also be more expensive.  The WHO has been resisting it for this reason It may produce more people being diagnosed since a rise in fasting blood glucose most often happens later in the progression of type 2. Indeed I have read doctors make comments that patients may have an HbA1c in the sevens yet  tests still show  impaired fasting glucose levels.


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