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Pre Diabetes A1c

Why Prediabetes?

Why Prediabetes?

Can we answer the question of how you can have a pre-disease that increases your risk of death? You either have it or you don’t! The ADA, ESAD, and AACE say that if you have an A1c of 5.7% to 6.4% you are prediabetic or have prediabetes. ADA says if you have an A1c of 7% or higher you have diabetes and the AACE says that if you have an A1c of 6.5% or higher you have diabetes. So the question is, who is correct? How can you have two major medical organizations saying two different things? Who should we believe? What do we tell our patients? On the other hand, what difference does it make? Both numbers mean that the amount of sugar in your blood is causing damage to every organ in your body. If you lose your eyesight or lose a leg or a kidney or even die from a heart attack, what difference does it make for your patients? Study data show fasting glucose concentrations of at least 100 mg/dL (5.6 mmol/L) or an HbA1c of at least 5.7% (39 mmol/mol) were determining factors.1 New research has shown that if you have prediabetes your risk for heart attacks and strokes goes up. So why do we wait for an A1c of 6.5 or 7% before we start to treat our patients? I guess we need to look to the FDA, ADA and other diabetes organizations to ask the question, “Why don’t we have any approved medications to treat prediabetes?” We have drugs like metformin that could make a major difference in preventing elevated blood sugars. We now have drugs like the SGLT-2 inhibitors that have been shown to reduce the risk of cardiovascular disease and even death by up to 38%. And if that is not a reason to treat patients earlier, than what about a drug like cycloset that has been shown to reduce heart attacks and strokes (MACE) by 58%? Do you remember when the definition of diabetes was a fasting Continue reading >>

Symptoms, Diagnosis & Monitoring Of Diabetes

Symptoms, Diagnosis & Monitoring Of Diabetes

According to the latest American Heart Association's Heart Disease and Stroke Statistics, about 8 million people 18 years and older in the United States have type 2 diabetes and do not know it. Often type 1 diabetes remains undiagnosed until symptoms become severe and hospitalization is required. Left untreated, diabetes can cause a number of health complications. That's why it's so important to both know what warning signs to look for and to see a health care provider regularly for routine wellness screenings. Symptoms In incidences of prediabetes, there are no symptoms. People may not be aware that they have type 1 or type 2 diabetes because they have no symptoms or because the symptoms are so mild that they go unnoticed for quite some time. However, some individuals do experience warning signs, so it's important to be familiar with them. Prediabetes Type 1 Diabetes Type 2 Diabetes No symptoms Increased or extreme thirst Increased thirst Increased appetite Increased appetite Increased fatigue Fatigue Increased or frequent urination Increased urination, especially at night Unusual weight loss Weight loss Blurred vision Blurred vision Fruity odor or breath Sores that do not heal In some cases, no symptoms In some cases, no symptoms If you have any of these symptoms, see your health care provider right away. Diabetes can only be diagnosed by your healthcare provider. Who should be tested for prediabetes and diabetes? The U.S. Department of Health and Human Services recommends that you should be tested if you are: If your blood glucose levels are in normal range, testing should be done about every three years. If you have prediabetes, you should be checked for diabetes every one to two years after diagnosis. Tests for Diagnosing Prediabetes and Diabetes There are three ty Continue reading >>

What Is Pre-diabetes?

What Is Pre-diabetes?

Q What is pre-diabetes? A Pre-diabetes is when your blood sugar is higher than normal but not as high as it would be with diabetes. Q Is pre-diabetes serious? A Yes, pre-diabetes is serious. • Pre-diabetes can lead to heart problems. • If you have pre-diabetes, you are at much higher risk of getting type 2 diabetes. • Type 2 diabetes can lead to other serious health problems with your eyes, kidneys, nerves and feet. Q How will I know if I have pre-diabetes? A • Ask your doctor for a blood test for pre-diabetes. • Even if you do not feel bad, you should get tested anyway. • 57 million people in the United States have pre-diabetes and do not know it. Q Who should be tested for pre-diabetes? A • All people 45 years and older should be tested for pre-diabetes. • You should also be tested if you are overweight and have one of the following: – Have a brother or sister or parent with diabetes. – Not physically active. – Have high blood pressure or a heart problem. – Cholesterol is not normal. – Had diabetes when you were pregnant or had a baby that weighed nine pounds or more. – Are Hispanic, African-American, American Indian or Asian. – Were ever told you had a “touch of diabetes,†“a little sugar†or “borderline diabetes.†Q What are the tests for pre-diabetes? A There are two blood tests that check your blood sugar: 1. Fasting Blood Sugar Test • You will fast for 8 hours before you take this test. • If your blood sugar is 100-125, you have pre-diabetes. • If your blood sugar is 126 or higher, you have diabetes. 2. A1C Test • This test measures your average blood sugar control for the last three months. • If your A1C is Continue reading >>

Hemoglobin A1c And The Diagnosis Of Diabetes And Prediabetes In Children And Adolescents

Hemoglobin A1c And The Diagnosis Of Diabetes And Prediabetes In Children And Adolescents

Margaret T. Hartig, Ph.D. Donna K. Hathaway, Ph.D. Matthew W. Strum, Pharm.D. Mona N. Wicks, Ph.D. Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold standard use of the fasting plasma glucose (FPG) and 2-hour oral glucose tolerance test (OGTT) to detect diabetes and prediabetes in a children and adolescents considered to be at higher risk for impaired glucose metabolism. In addition, ROC curve analysis was performed to determine optimal thresholds for the diagnosis of prediabetes in available groups of the research sample. The study also to examined the correlation between A1C and race and ethnicity, age, vitamin D levels, and body mass index, in addition to comparing the relationship of A1C to beta cell dysfunction and insulin sensitivity. A retrospective review of 902 patient electronic medical records in an urban endocrinology clinic was conducted. Based on FPG and 2-hr glucose during the OGTT, patients were classified based on the ADA 2014 criteria as having diabetes or prediabetes Subjects ranged in age from 2-18 (11.6 ± 3.32), were predominantly minority (70.7% African American, 17.3% Hispanic, 12.0% Caucasian) and female (60.7%). The results yielded a high specificity (99.7% Continue reading >>

Prediabetes - The Problem And How You Can Prevent It

Prediabetes - The Problem And How You Can Prevent It

Roughly one-third to one-half of adults currently have prediabetes, but does that statistic really matter? After all, these adults aren’t actually diabetic yet, so the health risk isn’t actually there, right? Wrong. UnityPoint Health Diabetes Steering Committee Chair, David Trachtenbarg, MD, talks about how to prevent diabetes, starting with prediabetes. What is Prediabetes? Prediabetes is a condition where blood sugar levels aren’t quite high enough to be classified as type 2 diabetes, but without change, will most likely develop into diabetes in as little as 10 years. “The large number of adults who already exhibit signs of prediabetes indicates that millions of people are at risk for developing a serious disease with many serious complications, diabetes,” Dr. Trachtenbarg says. This is the concern of health care providers across the country, so much so that some are labeling prediabetes as “an epidemic that’s out of control.” There’s good reason to take prediabetes seriously. Even before an adult is diagnosed with diabetes, prediabetes can start to have the same negative effects on the body. “Although much less common than with overt diabetes, if you have prediabetes, you are at increased risk for heart attacks and strokes, as well as kidney, nerve and eye problems. The best way to detect if someone has prediabetes is through a blood test,” Dr. Trachtenbarg says. Blood glucose, or blood sugar, is closely examined when determining a prediabetes diagnosis. For someone who is diabetic, a fasting blood glucose result would be 126 mg/dL (milligrams per deciliter) or higher. Prediabetes blood glucose results would fall in the 100-125 mg/dL range. A provider might also do another blood test, an A1C, which looks at hemoglobin levels. A1C results of 6.5 Continue reading >>

7 Natural Treatments Of Prediabetes Symptoms

7 Natural Treatments Of Prediabetes Symptoms

We know that diabetes is a major problem in the U.S., and prediabetes is not less of an issue — but it’s also a wakeup call that can jolt someone into action. Prediabetes symptoms may go unnoticed, but the first sign is that you no longer have normal blood sugar levels. A prediabetes diagnosis is a warning sign to people who will develop diabetes if they don’t make serious lifestyle changes. The Centers of Disease Control and Prevention National Diabetes Statistics Report says that 37 percent of United States adults older than 20 years and 51 percent of those older than 65 exhibit prediabetes symptoms. When applied to the entire population in 2012, these estimates suggest that there are nearly 86 million adults with prediabetes in the United States alone. Furthermore, the International Diabetes Federation projects an increase in prevalence of prediabetes to 471 million globally by 2035. (1) Luckily, research shows that lifestyle intervention may decrease the percentage of prediabetic patients who develop diabetes from 37 percent to 20 percent. (2) What Is Prediabetes? Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It’s considered to be an at-risk state, with high chances of developing diabetes. Without intervention, people with prediabetes are likely to become type 2 diabetics within 10 years. For people with prediabetes, the long-term damage to the heart and circulatory system that is associated with diabetes may have started already. (3) There are several ways to diagnose prediabetes. The A1C test measures your average blood glucose for the past two to three months. Diabetes is diagnosed at an A1C of greater than or equal to 6.5 percent; for prediabetes, the A1C is between 5.7 percent Continue reading >>

Corrigendum To “optimal Hemoglobin A1c Levels For Screening Of Diabetes And Prediabetes In The Japanese Population”

Corrigendum To “optimal Hemoglobin A1c Levels For Screening Of Diabetes And Prediabetes In The Japanese Population”

Journal of Diabetes Research Volume 2017 (2017), Article ID 7072538, 2 pages 1Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan 2Division of Companion Diagnostics, Department of Pathology of Microbiology, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan Copyright © 2017 Masanori Shimodaira et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Continue reading >>

Diagnosis

Diagnosis

Print The American Diabetes Association (ADA) recommends that blood glucose screening for adults begin at age 45, or sooner if you are overweight and have additional risk factors for prediabetes or type 2 diabetes. There are several blood tests for prediabetes. Glycated hemoglobin (A1C) test This test indicates your average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. In general: An A1C level below 5.7 percent is considered normal An A1C level between 5.7 and 6.4 percent is considered prediabetes An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (hemoglobin variant). Fasting blood sugar test A blood sample is taken after you fast for at least eight hours or overnight. In general: A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes. Oral glucose tolerance test This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. In general: A blood sugar level less than 140 mg/dL (7.8 mmo Continue reading >>

Utility Of Hemoglobin A1c For Diagnosing Prediabetes And Diabetes In Obese Children And Adolescents

Utility Of Hemoglobin A1c For Diagnosing Prediabetes And Diabetes In Obese Children And Adolescents

OBJECTIVE Hemoglobin A1c (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking. RESEARCH DESIGN AND METHODS We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of ∼2 years in 218 subjects. RESULTS At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (A1C <5.7%), 21% at risk for diabetes (A1C 5.7–6.4%), and 1% with diabetes (A1C >6.5%). In the at risk for diabetes category, 47% were classified with prediabetes or diabetes, and in the diabetes category, 62% were classified with type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1C was 0.81 (95% CI 0.70–0.92). The threshold for identifying type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1C and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time. CONCLUSIONS The American Diabetes Association suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1C by itself represents a poor diagnostic tool for prediabetes and type 2 diabetes in obese children Continue reading >>

Prediabetes? What Does It Mean For Your Kidneys?

Prediabetes? What Does It Mean For Your Kidneys?

Prediabetes describes the condition of someone who is on their way to developing diabetes. Before having diabetes, people usually have “pre-diabetes.” This is a new name for a condition in which blood glucose (sugar) levels are higher than normal but not yet high enough to be diagnosed as diabetes. A person with prediabetes cannot handle sugar as well as they should. Even though diabetes is not full blown, high sugar levels in prediabetes can be causing problems throughout the body. One of the main organs that can be damaged is the kidney. People with prediabetes often have unrecognized chronic kidney disease (CKD), according to new research. In this large study, more than one third of the people with prediabetes were found to have two signs of kidney disease: protein in the urine (called albuminuria). Albuminuria is not normal. reduced estimated glomerular filtration rate (eGFR). This is a measure of how well the kidneys work; the eGFR tells the stage of kidney disease. In the people with prediabetes, the stage of chronic kidney disease was just as advanced as people with diabetes. Many people with either prediabetes or diabetes were found to have stage 3 or 4 chronic kidney disease. There are 5 stages of chronic kidney disease. When the disease reaches stage 5, the person will need kidney replacement therapy, either transplantation or dialysis. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—have pre—diabetes. Without patients and their doctors taking action, prediabetes is likely to become type 2 diabetes in 10 years or less. People with prediabetes should know that the long—term damage to their body—especially to the heart, kidneys and blood vessels — may alread Continue reading >>

In Search Of The Optimal Definition Of Pre-diabetes

In Search Of The Optimal Definition Of Pre-diabetes

Defining pre-diabetes based on hemoglobin (Hb)A1c, an indicator of average long-term blood glucose levels, predicted long-term diabetes complications more accurately than other definitions of pre-diabetes, according to a study now online in Lancet Diabetes Endocrinology. After demographic adjustment, compared with fasting glucose-based definitions, HbA1c-based definitions of pre-diabetes had higher hazard ratios and better risk discrimination for several common diabetes complications (all P<0.05), wrote Elizabeth Selvin, PhD, Co-Director of the Cardiovascular Disease Epidemiology Training Program at Johns Hopkins Bloomberg School of Public Health, and colleagues. The results showed C (concordance)-statistics of 0.640 for chronic kidney disease, 0.672 for cardiovascular disease, 0.722 for peripheral arterial disease, and 0.688 for death from any cause. Participants identified as having pre-diabetes according to an A1C test-based definition had a 50% greater risk of developing kidney disease, twice the odds of developing cardiovascular disease, and a 60% increased risk of overall mortality compared with those with normal A1C, the researchers reported. In the absence of a national or international consensus on an optimal definition, a clear definition of pre-diabetes is needed "so we can know who to target for lifestyle modifications and other types of interventions, such as possibly glucose-lowering drugs," Selvin told MedPage Today via email. "If we don't have a clear definition of pre-diabetes, treatment recommendations and reimbursement for interventions such as weight loss and nutritional counseling can be a problem." To that end, researchers compared five different definitions of pre-diabetes, including two fasting glucose-based, two HbA1c-based, and one 2-hour gluco Continue reading >>

Using Hemoglobin A1c As A Predicting Model For Time Interval From Pre-diabetes Progressing To Diabetes

Using Hemoglobin A1c As A Predicting Model For Time Interval From Pre-diabetes Progressing To Diabetes

Abstract The early identification of subjects at high risk for diabetes is essential, thus, random rather than fasting plasma glucose is more useful. We aim to evaluate the time interval between pre-diabetes to diabetes with anti-diabetic drugs by using HbA1C as a diagnostic tool, and predicting it using a mathematic model. We used the Taipei Medical University Affiliated Hospital Patient Profile Database (AHPPD) from January-2007 to June-2011. The patients who progressed and were prescribed anti-diabetic drugs were selected from AHPPD. The mathematical model used to predict the time interval of HbA1C value ranged from 5.7% to 6.5% for diabetes progression. We predicted an average overall time interval for all participants in between 5.7% to 6.5% during a total of 907 days (standard error, 103 days). For each group found among 5.7% to 6.5% we determined 1169.3 days for the low risk group (i.e. 3.2 years), 1080.5 days (i.e. 2.96 years) for the increased risk group and 729.4 days (i.e. 1.99 years) for the diabetes group. This indicates the patients will take an average of 2.49 years to reach 6.5%. This prediction model is very useful to help prioritize the diagnosis at an early stage for targeting individuals with risk of diabetes. Using patients' HbA1C before anti-diabetes drugs are used we predicted the time interval from pre-diabetes progression to diabetes is 2.49 years without any influence of age and gender. Additional studies are needed to support this model for a long term prediction. Figures Citation: Huang C-L, Iqbal U, Nguyen P-A, Chen Z-F, Clinciu DL, Hsu Y-HE, et al. (2014) Using Hemoglobin A1C as a Predicting Model for Time Interval from Pre-Diabetes Progressing to Diabetes. PLoS ONE 9(8): e104263. Editor: Salomon Amar, Boston University, United States of Am Continue reading >>

5 Ways To Lower Your A1c

5 Ways To Lower Your A1c

For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>

Do I Have Prediabetes Or Diabetes? Guide To The A1c, Fpg, And Ogtt Tests, Plus Tips For Prevention

Do I Have Prediabetes Or Diabetes? Guide To The A1c, Fpg, And Ogtt Tests, Plus Tips For Prevention

If you’ve been diagnosed with prediabetes, you may wonder what that means. It’s a condition where your blood glucose levels are above normal, but not high enough for you to be diagnosed with diabetes. Many doctors consider prediabetes to be the first stage of type 2 diabetes. Studies show that 15 to 30 percent of people with prediabetes will develop diabetes in as little as five years without intervention, such as weight loss or increased physical activity. In fact, most people who get type 2 diabetes had prediabetes first. Prediabetes is serious in and of itself. People with this condition have a greater risk of developing cardiovascular disease than those without it. There are three tests that doctors can do in order to determine whether you have high blood sugar. A1C This blood test, which is also called hemoglobin A1c, HbA1c, or glycosylated hemoglobin, measures the percentage of sugar that is attached to your hemoglobin. Hemoglobin is a protein in your red blood cells. The higher the A1C, the higher your average blood sugar levels have been running over the past two or three months. A normal A1C is below 5.7 percent. An A1C between 5.7 percent and 6.4 percent suggests prediabetes. An A1C of 6.5 or more indicates type 2 diabetes if the test is confirmed. If your results are questionable, your doctor will retest your A1C on another day to confirm the diagnosis. Fasting plasma glucose The fasting plasma glucose (FPG) test is a blood test that’s done after you’ve been fasting overnight. It measures the sugar in your blood. A normal fasting glucose test is lower than 100 milligrams per deciliter (mg/dL). A result between 100 and 125 mg/dL is diagnostic for prediabetes. One that is 126 mg/dL or above is indicative of diabetes. It’s recommended to retest this an Continue reading >>

A1c Accurate At Identifying Prediabetes

A1c Accurate At Identifying Prediabetes

A routine blood test may be able to identify people with prediabetes as well as the fasting plasma glucose (FPG) test, the method currently used by some doctors for screening, according to a recent study funded in part by the US Centers for Disease Control. An estimated 57 million adults in the United States have prediabetes (a condition in which blood glucose levels are elevated, but not enough for a diagnosis of diabetes) and the vast majority don’t know it. The FPG test screens for diabetes by measuring the level of glucose in a person’s blood plasma after a period of fasting (not eating or drinking anything other than water). The test is performed after a person has fasted for at least 8 hours; people with a fasting plasma glucose level less than 126 mg/dl but greater than or equal to 100 mg/dl are classified as having prediabetes. Because the FPG test sometimes requires a second doctor’s visit for retesting, and because people often forget to arrive with an empty stomach, obtaining accurate results by the method can be difficult. The A1C test, currently used to check the level of blood glucose control over the previous 2–3 months in people with diabetes, only requires a single visit and is accurate regardless of whether a person has eaten prior to the visit. Based on blood test results from the 1,750 people included in the study, the A1C test is effective at pinpointing people who have prediabetes, and who are therefore at increased risk of developing Type 2 diabetes. (In 2010, the American Diabetes Association began recommending that the A1C test be used to diagnose Type 1 or Type 2 diabetes.) According to Ronald T. Ackerman, MD, MPH, lead author of the study “If you have high blood pressure or heart disease, or multiple other risk factors such as obesit Continue reading >>

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