His treatment recommendation was to increase his exercise , lose weight and recheck his lab test in 1 year.
He followed the advice and also started Omega 3 Fatty acids , taking over 4 Grams/day.
Lab test one year later - A1c 6 ( 53mm/L ) Fasting glucose 98 mg/dl ( 5.4 mm/L ).
Cholesterol is 195 mg/dl (5 mm/L )
LDL cholesterol is 131 mg/dl ( 3.4mm/L )
HDL is 36 mg/dl (.9 mm/L )
Triglycerides have decreased to 148mg/dl ( 1.7 mm/L )
Question . Which test , A1c or Fasting Glucose , is the most useful for diagnosing Pre-diabetes
Criteria for the diagnosis of Diabetes Criteria for diagnosis of Pre-Diabetes
A1c > 6.5 A1c 5.7 to 6.4
Fasting Glucose > 126 mg/dl ( 7 mm/l ) Fasting glucose 100mg/dl to 125 mg/dl
( 5.6 mm/l) to ( 6.9mm/l )
These lab results raise some interesting questions about our diagnostic tools .
The A1c test is generally thought to be less sensitive for the diagnosis of Diabetes than the Fasting
Glucose. The A1c results can be effected by pregnancy , hemolytic anemias , recent blood loss and
The American Diabetes Association suggested approach to the diagnosis of diabetes when A1c and Fasting glucose results do not agree is :
'The test whose result is above the diagnostic cut point should be repeated , and the diagnosis
in made on the basis of the confirmed test"
There is another interesting caveat when comparing A1c results with Fasting Glucose results Both fasting glucose or after meal glucose contributes to the A1c test.
The A1c test is an average of all glucose results for the previous 2 to 3 months.
For example the after meal glucose results contribute only about 25 % to an A1c level of 10.2 but contributes 75% to an A1c result of 7.3.
This means that the closer the A1c results get to 6.5 The greater the after meal sugar is contributing to the result.
With the above thoughts in mind I would tend to believe the A1c result and follow the ADA recommendations and repeat the A1c test.
This information is also useful for helping you decide whether to do more after meal test as your A1c hemoglobin approaches your A1c goal of 7
Tomorrow. What to do about the lipid test results ?
Have Fun, Be Smart and buy one of my Diabetes Office Visit Apps , ebook or paper back books or Iphone , iPad App.
David Calder, MD