Large Trial Compared Usual Tools For Assessing For Diabetes In Adults
The researchers looked at data from 9,000 adults, ages 20 years and older, from the 2005-2014 National Health and Nutrition Examination Survey . The information collected by the research team included body weight and blood test results.
Based on the fasting blood glucose test and the OGTT, 765 patients were diagnosed as having type 2 diabetes . However, only about 27% of these individuals were classified as having diabetes based on their A1c levels, which is how Dr. Villacreses and her team determined that nearly three-quarters of those at risk for diabetes were not aware that they had this chronic disease, and therefore were not receiving treatment.1
“Most worrisome, 73 % of patients would have missed out on early intervention and treatment,” she tells EndocrineWeb. While the A1c test is convenient, ”we recommend that we do not rely solely on this number,” Dr. Villacreses says.
The guidelines for diagnosis and treatment of type 2 diabetes from the American Diabetes Association already advise against relying solely on A1c,3 she says. While the American Diabetes Association guidelines specify that diabetes can be diagnosed based on fasting plasma glucose , the OGTT, or the A1c, our findings confirm that reliance on A1c remains the least reliable method for assessing diabetes risk.
How Precise Is The A1c Test
When repeated, the A1C test result can be slightly higher or lower than the first measurement. This means, for example, an A1C reported as 6.8 percent on one test could be reported in a range from 6.4 to 7.2 percent on a repeat test from the same blood sample.3 In the past, this range was larger but new, stricter quality-control standards mean more precise A1C test results.
Health care professionals can visit www.ngsp.org to find information about the precision of the A1C test used by their lab.
How Often Do You Measure A1c
Your doctor will want to see what your A1C results is 2-4 times a year, and will typically order this lab with other important labs when its time for your blood draw. You can buy at home A1c test kits at your local pharmacy for approximately $20-$40. The kits in this price range usually include 2 tests and you can see the results in about 5 minutes. It is possible to see a significant change in your A1C in a one month time period, but the test typically isnt done too often because red blood cells only turnover about every 120 days. On the plus side, if you have made some changes in the month prior to going to visit your doctor, those positive changes in the last 30 days are going to make more of an impact on your result than what you did 2 months ago.
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Is There Anything Else I Need To Know About Fasting Before A Blood Test
Be sure to talk to your health care provider if you have any questions or concerns about fasting.
You should talk to your provider before taking any lab test. Most tests don’t require fasting or other special preparations. For others, you may need to avoid certain foods, medicines, or activities. Taking the right steps before testing helps ensure your results will be accurate.
A1c Captures Chronic Hyperglycemia Better Than Two Assessments Of Fasting Or 2
Diabetes has been diagnosed for decades with fasting plasma glucose assessment or, much less frequently, with an oral glucose tolerance test . Hyperglycemia as the biochemical hallmark of diabetes is unquestionable. However, fasting and 2-h OGTT gauge just a moment of a single day. In addition, the two assessments required to confirm diagnosis might be fallacious in describing a chronic and complex clinical condition. In this respect, there is no doubt that a biochemical or clinical parameter describing the extent of a biological phenomenon over a long period provides a more robust indicator of glycemia than a parameter describing it in the short term or in a given moment only. Accordingly, there are some good examples in medicine: urinary albumin excretion rate provides more reliable information on the presence and the degree of microalbuminuria than spot urinary albumin-to-creatinine ratio serum IGF-I is definitely more efficacious than serum growth hormone when monitoring patients with acromegaly, etc.
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Diabetes Tracking And Treatment
- Follow your diabetes treatment plan: Understand the treatment plan before leaving the healthcare providers office and discuss barriers that could prevent you from following the program. Attend all follow-up visits.
- Consistently take prescribed medications: If a healthcare provider has prescribed medications to reduce blood sugar levels, take them regularly. Some people only take medication when they arent feeling well, but these medications dont work unless taken consistently.
- Monitor and track blood sugar: Regular blood sugar monitoring is the most important step in diabetes management, according to the CDC. Healthcare providers can inform patients of different types of meters and help patients find the best one for them. Providers can also tell patients how often to check their blood sugar and what their target blood sugar range is.Keep a log of your blood sugar levels to look for patterns and triggers for blood sugar spikes and lows. If you wear a continuous glucose monitor, you can use the data. Learning what causes blood sugar to rise or decrease can help you create a plan to keep it consistent.
The 411 On A1c: Normal A1c Levels And 15 Ways To Lower High A1c
The hemoglobin A1C test is the closest thing to a diabetes scorecard you can find. Whether someone has had diabetes mellitus for years or if they have just been diagnosed, they have probably heard about this test. Unlike blood sugar meters people use at home, the A1C measures an average blood sugar level over the past several months by analyzing how many of a patients hemoglobin cells have glucose attached to them. The test results keep track of how well a person is managing his or her diabetes.
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You Have Disorders Related To The Spleen
Spleen disorders, like sickle cell or asplenia, can also affect your A1C tests. If you think your levels are suspect and have one of these disorders, that may be the culprit. As the NIH found, these disorders render tests less accurate when a patient inherits a hemoglobin variant.
Thereâs a word for this group of inherited disorders passed down over generations. Take a deep breath before you attempt to say itâthey’re called hemoglobinopathies. If you suffer from any of this, you could start to see false highs in your test results.
High A1c No Symptoms Of High Blood Sugar
If your A1C was high but you don’t really have symptoms of high blood sugar, you may have another A1C test done.
Alternatively, your healthcare provider may decide to do a fasting plasma glucose test or a two-hour glucose tolerance test right away instead.
In order to confirm the diagnosis of diabetes without the obvious symptoms of high blood sugar, two test results have to be abnormal. That could be two results of the same test , or one result of one and one result of another.
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Eat A Balanced Diet With Proper Portion Sizes
Its best to check with a certified diabetes care and education specialist or a registered dietitian-nutritionist to determine what a balanced diet and appropriate portions mean for you. But a great rule of thumb is to visualize your plate for every meal and aim to fill one-half of it with veggies, one-quarter with protein, and one-quarter with whole grains, says Turkel. If you like fruit, limit your portions to a small cup, eaten with a little protein or lean fat to help you digest the fruit carbohydrates in a manner that is less likely to spike your blood sugar level.
Also, avoid processed foods as much as possible, and say no to sugary sodas and fruit juice, which are high in carbs and calories, and thus can lead to spikes in blood sugar and contribute to weight gain, according to the ADA.
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What Are The Top Tips For Lowering A1c
Your A1C score is a valuable part of the diabetes control picture, Dodell says, but it is not the only indicator of your health. Someone who has wide fluctuations in blood sugar levels may have an A1C at goal because the average over two to three months is good. But the day-to-day fluctuations can lower your quality of life and increase your risk of complications, he cautions.
Diabetes can be a tough condition to manage, Dodell says. He tells his patients to view diabetes management like a job. It takes work, but the time and effort you put into it can result in good control and an improved quality of life. The key to reaching your A1C goal is trying to follow a healthy lifestyle, he says.
Making these healthy changes can help you improve your day-to-day blood sugar management and lower your A1C:
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What Does An A1c Test Measure
An A1C test measures the percentage of hemoglobin in your blood that carries glucose. The higher the amount of glucose in the blood, the higher the A1C percentage. A normal A1C measurement is less than 5.7%, while an A1C of 5.7% to 6.4% could suggest prediabetes, and an A1C of 6.5% or higher usually means diabetes.
The great thing about an A1C test is that it represents your average blood sugar levels over 2 to 3 months. In other words, it isnt affected by the pizza you had the night before, and you dont have to fast for the test to be accurate. Thats because glucose stays attached to hemoglobin for as long as the red blood cell that holds them remains in your bloodstream .
Certain health conditions that affect your blood and hemoglobin can cause your HbA1C test to be inaccurate.
What Does This Mean For People Wondering About Their Diabetes Risk
For individuals who havent received a diagnosis of diabetes, Dr. Villacreses says, one important lesson from these fidings is that ”you should not feel 100% reassured if your A1c number is less than 6.5% that you are do not have diabetes. A test result that is greater than 6.4% defines the beginning of diabetes, so you may have prediabetes or have already progressed to type 2 diabetes.
The sooner you receive a diagnosis regarding your diabetes status, the earlier treatment can begin. This is important because by understanding your risks, and making the necessary lifestyle changes, you can prevent prediabetes from progressing or even reverse the type 2 diabetes.
In addition, she says, patients should feel comfortable asking their doctor about the choice of tests and indicate your desire to skip the A1c, and have one of the other more reliable screening methods, while more time consuming, to determine if you are at risk for pre-diabetes or diabetes.
Dr. Villacreses has received research funding and speaking fees from a variety of pharmaceutical companies but none that pose a conflict in this research. Dr. Christofides has no relevant financial disclosures.
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How Often Do You Need The Test
Your doctor probably will have you take the A1c test as soon as youâre diagnosed with diabetes. Youâll also have the test if your doctor thinks you may get diabetes. The test will set a baseline level so you can see how well youâre controlling your blood sugar.
How often youâll need the test after that depends on several things, like:
- The type of diabetes you have
- Your blood sugar control
- Your treatment plan
Youâll probably get tested once a year if you have prediabetes, which means you have a strong chance of developing diabetes.
You may get tested twice each year if you have type 2 diabetes, don’t use insulin, and your blood sugar level is usually in your target range.
You could get it three or four times each year if you have type 1 diabetes.
Youâll likely get four tests per year if you have type 2 diabetes and use insulin, or have trouble keeping your blood sugar level in your target range.
You may also need the test more often if your diabetes plan changes or you start a new medicine.
What Does The A1c Test Measure
When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells. Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.
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Follow The Diabetes Treatment Plan Your Healthcare Team Recommends
Diabetes treatment is very individualized, noted an article published in May 2014 in Diabetes Spectrum. After all, factors including how long youve lived with the disease, your socioeconomic status, and any other conditions youre living with can play a role in the best treatment approach for you.
Your healthcare team will help you determine the steps you need to take to successfully manage diabetes. Always talk to your doctor before making any changes, such as starting a very-low-carbohydrate diet or beginning a new exercise regimen, and especially before making any medication or insulin changes.
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Can The A1c Test Result In A Different Diagnosis Than The Blood Glucose Tests
Yes. In some people, a blood glucose test may show diabetes when an A1C test does not. The reverse can also occuran A1C test may indicate diabetes even though a blood glucose test does not. Because of these differences in test results, health care professionals repeat tests before making a diagnosis.
People with differing test results may be in an early stage of the disease, when blood glucose levels have not risen high enough to show up on every test. In this case, health care professionals may choose to follow the person closely and repeat the test in several months.
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How Much Does The Test Cost
The full cost of a hemoglobin A1c test depends on many variables, such as what type of hemoglobin A1c test your doctor orders for you, where the test is performed, whether you have medical insurance, and how much of the test cost your insurance provider will cover.
Hemoglobin A1c testing can involve several different charges. These can include fees charged by the laboratory for the technicians labor and the analysis of your sample, as well as the costs of your visits to your doctors office to receive the test or discuss its results.
If your doctor has ordered an hemoglobin A1c test for you, many of these charges will be paid in part or in full by your insurance company. But you may still be responsible for out-of-pocket expenses such as deductibles or copayments. Your doctor or insurance provider can give you more information about the costs that you can expect to pay.
The price of an at-home hemoglobin A1c test device can vary greatly depending on the model and manufacturer, the number of tests that come with the kit, and whether the device is covered by your insurance. You may also need to pay for replacement cartridges or other components if you use the device regularly.
What Is A Good A1c Level
Levels between 5.7 and 6.4 are considered prediabetes. For most people with diabetes, the general A1C goal is to have a level between 6.0 and 6.9. While it might sound like the ideal A1C target is under 6.0, for those with diabetes, this level can indicate low blood sugar levels, which can be just as dangerous as high blood sugar levels. If A1C results fall between 7.0 and 8.9, a doctor might suggest lifestyle changes or medications to help lower the levels to what is considered controlled. However, for some people, these levels might be appropriate, such as:
- Those with a limited life expectancy
- People with long-standing diabetes who have trouble reaching a lower goal
- Those with severe hypoglycemia or the inability to sense hypoglycemia
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You Have Hemoglobin Type C D Or E
Did you know there were various variants of hemoglobin? Itâs not common to know your type, but if youâre wondering whatâs leading to elevated A1C levels, you may want to check. The most common is Hemoglobin A.
According to research by the government in British Columbia, Canada, there are 350 varieties. Type C, for example, doesnât carry oxygen very well, which can affect A1C levels. Then thereâs Type E, an inherited blood disorder most common among people of Southeast Asian descent. It can also record false high levels of A1C in your system. To find out what types you have, itâs a good idea to take a blood test called the hemoglobin electrophoresis test.
Elizabeth Ebner Ms Rd Cde
A1C% can be lowered with primarily increasing post meal activity, carbohydrate counting and medication. As a dietitian I focus on the first two and can often get the A1C% down 1-2% points. This is so empowering to the patients because it puts responsibility on their own behavior changes. Exercise can really help in their insulin sensitivity, so post meal exercise can be very impactful. I sometime recommend that they take a pre and post exercise blood glucose to see the effect it has. Meal planning and making / keeping a food log is VERY important as well.
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