Posted on 07/02/2009 12:12:52 AM PDT by neverdem
As far as I know, once per quarter is the norm. I have it every 3-6 months.
The average always downplays the extreme. Statistically, an average without contextual “swing” information is nearly meaningless.
I do not yet see exceptional merit in the reasoning behind this change. I do see powerful monetary reasons to suspect the decision.
BTW, to say that the A1C “has been accepted” when the change has just been proposed is premature, IMO.
......“has been accepted”......
ok, I’ll concede that statement as too specific.
My personal physician made the diagnosis after watching the fasting glucose results for a while. He than introduced the A1c and it now seems to be the primary number in spite of considerable variance in the fasting glucose.
I think perhaps your fixation on cost is misplaced because to obtain a continuous data stream, it is necessary to record fasting sugar daily and plot a curve. Then take the curve and plot a moving average. Why bother? The A1C does the job nicely while eliminating a lot of bother and other tests.
This is especially true for those of us at the low end of the numbers.
I was able to rely more on the HbA1C before I started insulin. I need the instant feedback to control dosage, in part.
My fixation on cost isn’t the consumer end, but rather the producer end. I’m afraid I have become fairly jaded regarding the incidence of monetary considerations infecting legal and medical decisions. Honestly, I would be surprised if there wasn’t lobbying for this outcome by the HbA1C labs or test kit makers. After all, some of the biggest proponents of the child-safety-seat laws (now up to 8 years old in some places!) were the child-seat makers.
In my industry (safety critical software), the small, in-process verification steps are complementary to the larger, milestone steps. I see the daily (or more often) plasma glucose reading as the self-check, with the HbA1C as the higher-level check.
Oh, wow - high numbers. Mine was taken in March and came in at 7.6. I had to insist on it being taken, and that was how I finally got my doctor’s attention.
Five years ago, at age 65 and after 3 years of progressive loss of feeling in my feet, and my Dr always instructing me to fast before each appointment, my A1c was about 7.5 - although my fasting glucose was normal. He never did a glucose tolerance test.
He handed me a copy of a “diabetic diet” brochure and a prescription for a meter, along with instructions to just monitor my glucose for a week. I learned that non-diet soft drinks, sweet & sour pork over a small mountain of rice, or a loaded baked potato sent my glucose above 240. Bread and pasta also raised it, but not as much.
But the diabetic diet seemed to emphasize carbohydrates! So after some research I settled on a pretty informal low-carb diet - except for various fruits - which I have adhered to ever since. My glucose averages under 100, measured morning and night, and my A1c is back to 5.5.
Am I diabetic? I still have peripheral neuropathy, and my opthalmologist has found early cataracts in both eyes, as well as early “low-tension” glaucoma that I am treating with eyedrops. And when I drank a mint julep (sugar syrup and bourbon) last Derby day at my wife’s UofL alumni party, my glucose paid another visit to 200+!
This can be very dangerous and mislead a person who is on a sugar roller coaster that he is doing OK when he is not.
I know the problem well... I’m trying to recover from it right now.
The a1c has been the bell-weather of control since it became available.
The bottom line is this: Most of us know when we're doing something to make the situation better or worse. I don't need a meter to tell me that the hot dog I just ate on that sweet, white bun is going to cause a big jump in my BG for a couple of hours.
Further, my fasting BG is going to be dependent on how I treated myself yesterday.
I am not arguing against the HbA1C test by any means. I am simply stating a truth - that the A1C can be fooled, just like any other test, including plasma glucose tests.
I am also questioning the motivation for the change in test standard, as well as any modification to the range of numbers that are considered to be diabetic. That’s not a refutation of the science.
I will retract my criticism of the HbA1C test just as soon as someone can prove it isn’t possible to foll it (which necessarily includes re-diagnosing the issue I am dealing with now, along with my doctors). Until someone can refute the truth, my criticism stands.
As do my questions regarding motivation.
I don't understand. Are you saying it can be manipulated in some way? Something along the lines of: If a perfectly healthy athlete munches on gummy bears all day it will result in a higher a1c?
HbA1C is an average (a “mean” in statistics). There is a companion piece of information used in statistics called a “standard deviation”, which indicates the variability of the data sample. The HbA1C does not provide any way to measure the standard deviation, which means that wild gyrations cannot be accounted for.
The average value for the data set {48, 49, 50, 51, 52} is 50.
Similarly, the average value for the data set {10, 20, 50, 80, 90} is 50, but the standard deviation is over 35 (as opposed to 1.58 for the other data set).
2/3 of all data values are expected to fall within one standard deviation of the mean. 98 or 99 percent of all values are expected to fall within two standard deviations of the mean. The variability of the second data set means that the average value is unreliable for predicting any particular instantaneous value.
Now, with respect to blood sugar, consider that non-diabetics are expected to have a low variability in their sugar readings. Therefore, the HbA1C’s ignoring the variability is of no real concern.
But a diabetic who varies wildly around a “normal” mean value will be shown by the same HbA1C test to fall within the expected range - thereby missing the diagnosis. Because of the variability, the instantaneous reading is a better option for diagnosing the issue.
That’s what I meant by “fooling” the test - the fact that highly variable data can invalidate the outcome. My recent 6.6% reading (approximately 158 mg/dl average) directly conflicts with the 205 mg/dl fasting sugar average (with a standard deviation of 45). In fact, the HbA1C fell below the range in which two-thirds of all of my sugar readings are expected to fall - and this was the fasting sugar.
That means that I was experiencing wild swings around a high but relatively benign sugar reading. With some of the numbers I was seeing, I had to be going seriously low at least once a day.
The bottom line to me is that an average without variability info is incomplete data. There may be mitigating factors due to the biology of the situation, but I’m not convinced this is the best route forward.
Of course, I’m just one guy expressing his opinion, too! ;-P
As a result; they can dupe even more people into consuming even MORE high-priced 'medication'. Quit eating garbage, America...bye-bye, Type 2.
Five years ago, at age 65 and after 3 years of progressive loss of feeling in my feet, and my Dr always instructing me to fast before each appointment, my A1c was about 7.5 - although my fasting glucose was normal. He never did a glucose tolerance test.
He handed me a copy of a “diabetic diet” brochure and a prescription for a meter, along with instructions to just monitor my glucose for a week. I learned that non-diet soft drinks, sweet & sour pork over a small mountain of rice, or a loaded baked potato sent my glucose above 240. Bread and pasta also raised it, but not as much.
But the diabetic diet seemed to emphasize carbohydrates! So after some research I settled on a pretty informal low-carb diet - except for various fruits - which I have adhered to ever since. My glucose averages under 100, measured morning and night, and my A1c is back to 5.5.
Am I diabetic? I still have peripheral neuropathy, and my opthalmologist has found early cataracts in both eyes, as well as early “low-tension” glaucoma that I am treating with eyedrops. And when I drank a mint julep (sugar syrup and bourbon) last Derby day at my wife’s UofL alumni party, my glucose paid another visit to 200+!
The confusion in the Medical field was rampant. Most doctors then thought you treated Type I and Type II the same way: Insulin. I sensed the confusion and did the research. I had two Doctors prescribing Insulin and an ADA diet with lots of carbohydrates. I feel the L-rd led me to a Christian Doctor who used Ha1c I was able to stop the Insulin and take Glucophage( Metformin ), diet and exercise. I bought a Bowflex and began serious resistance training. I began to do two Protein drinks and one meal a day. My Ha1c dropped to below 5. Later, I sold the Bowflex. My wife and I began an Atkins diet and my BS dropped 100 points in three weeks. My drink of choice now is Dalwhinnie over shaved ice, I, like you, was diagnosed as a Type II Diabetic fifteen years ago when I was fifty-five.
shalom b'SHEM Yah'shua HaMashiach
and had been made aware of Metabolic Disorder with a Dr Ron Rosedale.
Recently my feet began hurting, I started daily testing: BS of 240.
Palin Settles on Hemoglobin A1c to Diagnose Diabetes: Implications of the shift to be assessed.
This will be good because it won’t just be the bloodsugar reading at the time but the average of what it has been for the last 8-12 weeks.
My Dr. here in town has been using that for several years now. :)
They lowered the number to 6 because damage begins to happen to the body if the numbers tun over 6.5 for very long. How is more research a bad thing?
My last one was higher than it’s been in a while and it was 6.0. Need to get it back down into the 5.5 and under range.
.....I am an opinionated, brash, sometimes loud-mouth....
Yes, but are you educated?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.