American Diabetes Association recommends A1C test for diagnosing diabetes and identifying pre-diabetes

The American Diabetes Association's new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1C test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.

"We believe that use of the A1C, because it doesn't require fasting, will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, American Diabetes Association. "Unlike many chronic diseases, type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."

A1C is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1C of about 5 percent. Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1C of 5.7 - 6.4 percent would indicate that blood glucose levels were in the prediabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1C of 6.5 percent or higher.

The American Diabetes Association recommends that most people with diabetes maintain a goal of keeping A1C levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.

The A1C would join two previous diagnostic tests for diabetes, FPG (Fasting Plasma Glucose) and the OGTT (Oral Glucose Tolerance Test), both of which require overnight fasting. Because the A1C is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have type 2 diabetes but don't yet know it. According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.

To obtain a copy of the Standards of Medical Care in Diabetes, please contact [email protected].

End Stage Renal Disease Declines among People with Diabetes

In a study being published in the January issue of Diabetes Care, the incidence of End Stage Renal Disease (ESRD), or kidney failure, has begun a steady decline among people with diabetes after rising steadily for years, likely due to improvements in treatment and care that reduce dangerous risk factors.

Diabetes is the leading cause of ESRD, a life-threatening condition that requires patients to undergo dialysis or transplantation to survive. It now accounts for 44 percent of all new cases of kidney failure, rising from 17,727 Americans (with diabetes) in 1990 to 48,215 in 2006. However, researchers at the Centers for Disease Control and Prevention (CDC) found, from 1997-2006, the age-adjusted incidence of ESRD among the diabetes population fell from 343.2 people per 100,000 to 197.7 per 100,000, or a decline of 3.9 percent per year.

The decreasing trend was noted in all age groups and among both men and women, as well as among both Caucasians and African Americans. However, significant declines were not found among Hispanics.

"This suggests that current efforts to prevent ESRD may be successful among many people with diabetes," said Lead Researcher Nilka Ríos Burrows, Epidemiologist with CDC's Division of Diabetes Translation. "However, it's clear that more attention needs to be paid to prevention efforts among Hispanics."

While this study did not examine why the incidence of ESRD has begun to decline, the researchers speculate it is likely the result of improved treatment and care, better control of ESRD risk factors (such as high blood glucose levels and high blood pressure), and potentially the use of medications such as ACE inhibitors and angiotensin-receptor blockers that may offer some protection to the kidneys.