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A1c Screening Recommendations

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 >>

Hemoglobin A1c (hba1c) Values Alert Screening Participants With Normal Glucose Measurements To Diabetes Risk

Hemoglobin A1c (hba1c) Values Alert Screening Participants With Normal Glucose Measurements To Diabetes Risk

We announced last week that over a quarter of a million people were screened during our $1 per screening campaign (up to $200,000) benefiting the American Diabetes Association. As we do in all of our employer wellness screenings, this campaign allowed us to alert individuals to their health risks, educating them and motivating them to make lifestyle changes that can help them lead healthier lives. Of the individuals screened with either a fasting glucose or HbA1c test, 30% were found to be within the prediabetes or type 2 diabetes range (either having a blood glucose measurement greater than or equal to 100mg/dL, or an HbA1c value greater than or equal to 5.7%). 30% of those screened with an HbA1c and/or fasting glucose test were withinthe prediabetes or type 2 diabetes range 35% of those with fasting glucose and HbA1c measurements had an elevated HbA1c but a normal fasting glucose Perhaps more importantly, of those screened for both fasting glucose and HbA1c, we found that 35% of those with an elevated HbA1c had a normal fasting glucose. The value in the HbA1c test is that it gives participants an idea of their blood glucose levels over a two-to-three-month span, which may assist in identifying prediabetes and type 2 diabetes more so than a fasting glucose measurement, which only determines blood glucose levels at the instant the specimen is obtained. In the Quest Diagnostics database in 2016, for every four employee participants who had glucose measured, only one employee participant had an HbA1c measurement. By offering only a glucose test as part of an employer-sponsored wellness screening, 75% of employers may be missing an important opportunity to give employees significant insight into their prediabetes or diabetes risk. According to the American Diabetes Associa Continue reading >>

Ada Recommends The A1c Test For Diabetes Screening And Diagnosis

Ada Recommends The A1c Test For Diabetes Screening And Diagnosis

New official guidelines for diabetes screening and diagnosis now include a blood test that gives a person's average blood glucose level over the previous 2-3 months. The A1C test is not new. It has been used since the late 1970s as a way to get a snapshot of how well glucose control is going in people with diabetes. But only in the last 15 years has its use and scoring become more standardized and reproducible from place to place and time to time than other diabetes blood glucose tests. Now, in an annual supplement to the journal Diabetes Care, published Dec. 29 by the American Diabetes Association, the A1C test is given a prominent role in the 2010 guidelines for diabetes screening, diagnosis and prevention. In particular, the section "Revisions to the Standards of Medical Care in Diabetes," recommends that the A1C be used to identify people with "pre-diabetes," those at increased risk for developing the type 2 form of disease. Unlike type 1 diabetes with its sudden onset, type 2 develops gradually and without symptoms. But its damage to health and longevity can be equally severe. At least 50 million adults and children in the U.S. may be well on their way to developing type 2 diabetes, according to John Buse, M.D., Ph.D., professor of medicine and endocrinology chief at the University of North Carolina at Chapel Hill. Buse is former ADA president for medicine and science and a member of the International Expert Committee whose report in July 2009 strongly recommended the A1C assay for diabetes diagnosis and for identifying people at high risk for diabetes. "One big advantage of the A1C test is that it doesn't require fasting. The patient can come in any day, at any time. It's also not as skittish as the older blood sugar test which can be increased by the kind of comp Continue reading >>

Experts Back Switch To New Diabetes Test

Experts Back Switch To New Diabetes Test

Diabetes experts on Friday urged a switch to a diagnostic test for the disease that's more useful to primary care doctors and more convenient for patients because it doesn't require fasting. An international panel recommended that a test known as the hemoglobin A1c assay be the new standard test for diabetes. In the past, this test has primarily been used to monitor if diabetes treatment is working. However, the committee -- which unveiled its recommendations at this weekend's American Diabetes Association meeting in New Orleans, La. -- said the A1c test's long-term measurement of chronic blood sugar control problems provides a better diagnosis than current "snapshot" tests. Play The test has not been adopted by all doctors for diagnostic purposes. Many of them prefer to rely first on the tried-and-true techniques such as the standard fasting plasma glucose test (FPG) and the less common oral glucose tolerance test -- tests that the A1c screening would unseat as the new standard. Still, other physicians have welcomed the new screening. Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York, said many colleagues have been "waiting years for this to happen." Proponents favor the A1c because it measures average blood glucose over the preceding two to three months, rather than just at one point in time, the researchers said. "A1c values vary less than fasting plasma glucose values, and the assay for A1c has technical advantages compared with the glucose assay," said Dr. David M. Nathan of Massachusetts General Hospital, who chaired the expert committee. "Also, testing for diabetes using A1c is more convenient and easier for patients who will no longer be required to perform a fasting or oral glucose tolerance test," Nathan added Continue reading >>

Wdc: Hemoglobin A1c Screening Catches Diabetes In The Hospital

Wdc: Hemoglobin A1c Screening Catches Diabetes In The Hospital

WDC: Hemoglobin A1c screening catches diabetes in the hospital Vancouver, B.C. If a patient is admitted to the hospital with a plasma glucose at or above 140 mg/dL, its wise to check the hemoglobin A1c level to catch undiagnosed diabetes, according to British and Irish researchers. A combination of admission plasma glucose and hemoglobin A1c can be used to diagnose diabetes in acute medicine, provided care is taken when interpreting hemoglobin A1c results, as they can be affected by various medical conditions or certain drugs, said investigator Dr. Sandip Ghosh , a diabetologist at Queen Elizabeth Hospital in Birmingham, England. The conclusion comes from a review of 2,061 white inpatients at University Hospital Waterford (Ireland), 412 (20%) of whom were diagnosed with diabetes on admission or displayed symptoms and complications. An admission plasma glucose level of 140.4 mg/dL correlated with a hemoglobin A1c of 6.5%, the threshold for diabetes diagnosis. If ordering a hemoglobin A1c is delayed until the plasma glucose reaches 200 mg/dL, we are missing an awful lot of people with diabetes, Dr. Ghosh said. The linear correlation between admission plasma glucose and hemoglobin A1c levels wasnt perfect (r2 = 0.63, P less than 0.001). The approach was highly specific but not very sensitive, possibly because of a hemoglobin A1c level that has been compromised by liver, renal, or other problems, said investigator Susan Manley, Ph.D., a biochemist at the Birmingham hospital. The Joint British Diabetes Society is planning to release a nationwide guideline for diabetes screening at hospital admission, but the quickest and most cost-effective way to screen for diabetes is uncertain. Dr. Ghosh and Dr. Manley are both involved with those efforts, and their study is an attempt t Continue reading >>

Health Screenings

Health Screenings

A1c An A1c screening helps you understand how well your blood sugar has been controlled over a period of time. Blood sugar values fluctuate over the course of a day or week, so an A1c gives you a picture of your average blood sugar over the past three months. Learn more Blood Pressure It is important to make sure your blood pressure is within target range/at the goal you and your doctor have discussed to prevent complications such as heart attack, stroke, kidney disease and heart failure. Learn more Cholesterol Blood Cholesterol is a normal part of your blood and cells, and an important part of a healthy body. You get cholesterol in two ways: your body makes some of it, and the rest is made from the foods you eat. How much your body produces plus what you eat makes a difference in your health. Learn more Blood Glucose Blood glucose, also known as blood sugar, is the amount of glucose in your blood and important for everyone as a source of energy. When carbohydrate-containing foods are eaten, your body breaks them down into glucose, using it for energy. While everyone has blood glucose, people with diabetes have a different way of managing it with lifestyle choices to keep their levels within target range. Learn more A1c What is an A1c test? An A1c screening can help you understand how well your blood sugar has been controlled over a period of time. Though you may have some high or low blood sugar values, an A1c gives you a picture of your average blood sugar over the past three months, giving you a more accurate idea if your lifestyle choices and any prescribed medications are helping you keep your numbers in target range. Your A1c number can be converted to an average blood glucose value to help you, your doctor and Pharmacist identify if any changes are needed in your Continue reading >>

Test Id: Hba1c Hemoglobin A1c, Blood

Test Id: Hba1c Hemoglobin A1c, Blood

Evaluating the long-term control of blood glucose concentrations in diabetic patients Diagnosing diabetes Identifying patients at increased risk for diabetes (prediabetes) Diabetes mellitus is a chronic disorder associated with disturbances in carbohydrate, fat, and protein metabolism characterized by hyperglycemia. It is one of the most prevalent diseases, affecting approximately 24 million individuals in the United States. Long-term treatment of the disease emphasizes control of blood glucose levels to prevent the acute complications of ketosis and hyperglycemia. In addition, long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease can be minimized if blood glucose levels are effectively controlled. Hemoglobin A1c (HbA1c) is a result of the nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. The attachment of the hexose molecule occurs continually over the entire life span of the erythrocyte and is dependent on blood glucose concentration and the duration of exposure of the erythrocyte to blood glucose. Therefore, the HbA1c level reflects the mean glucose concentration over the previous period (approximately 8-12 weeks, depending on the individual) and provides a much better indication of long-term glycemic control than blood and urinary glucose determinations. Diabetic patients with very high blood concentrations of glucose have from 2 to 3 times more HbA1c than normal individuals. Diagnosis of diabetes includes 1 of the following: -Fasting plasma glucose > or =126 mg/dL -Symptoms of hyperglycemia and random plasma glucose >or =200 mg/dL -Two-hour glucose > or =200 mg/dL during oral glucose tolerance test unless there is unequivocal hyperglycemia, confirmatory testing should be Continue reading >>

Ada Releases 2018 Standards Of Care For Diabetes

Ada Releases 2018 Standards Of Care For Diabetes

The American Diabetes Association (ADA) has released their annual Standards of Medical Care in Diabetes for 2018, highlighting several updated recommendations for diabetes care and management. Based on current research findings, the standards offer comprehensive practice evidence-based recommendations. The updated guidelines address the use of the medications with potential cardiovascular (CV) benefit. Other areas addressed include diabetes screening, technology, and A1C tests. Some of the most notable changes are summarized below. Cardiovascular Disease and Diabetes New guidelines incorporate the use of diabetes drugs with known cardiovascular benefit. For adults with type 2 diabetes and heart disease, the ADA recommends that, after lifestyle management and metformin, health care providers should include a medication proven to improve heart health. In the clip below, Dhiren Patel, PharmD, discusses the importance of the new recommendations for diabetes care, including the use of diabetes medications with CV risk. All hypertensive patients with diabetes are encouraged to monitor their blood pressure at home to help identify potential discrepancies between office vs. home blood pressure, and to improve medication-taking behavior, according to the guidelines. The new ADA standards also continue with the existing hypertension definition, as opposed to the American College of Cardiology’s recently updated blood pressure guidelines. The ADA’s guidelines state that most adults with diabetes and hypertension should have a target blood pressure of <140/90 mmHg and that risk-based individualization lowers targets, such as 130/80 mmHg, may be appropriate in some patients. In the clip below, Dhiren Patel, PharmD, discusses the importance of the new recommendations for diabetes Continue reading >>

Hemoglobin A1c Inadequate For Postpartum Diabetes Screening

Hemoglobin A1c Inadequate For Postpartum Diabetes Screening

Hemoglobin A1C Inadequate for Postpartum Diabetes Screening Hemoglobin A1C Inadequate for Postpartum Diabetes Screening (HealthDay News) For postpartum women who have had gestational diabetes mellitus (GDM), the hemoglobin A1c (A1C) test criteria alone or in combination with fasting glucose test criteria does not provide sensitive and specific diagnosis of abnormal carbohydrate metabolism compared with the gold-standard oral glucose tolerance test (OGTT). Mara Jos Picn, MD, PhD, of the Virgen de la Victoria University Hospital in Malaga, Spain, and colleagues measured the sensitivity and positive predictive value (PPV) of the A1C test, with or without the fasting glucose test, compared with the OGTT in 231 postpartum women with prior GDM one year after delivery. The researchers found that, based on the OGTT, A1C test, fasting glucose test, and A1C-fasting glucose test criteria, the prevalence of abnormal carbohydrate metabolism was 45.89, 19.05, 38.1, and 46.75%, respectively. Compared with the OGTT, the A1C test had a sensitivity and PPV of 22.64 and 54.55%, respectively; while the fasting glucose criterion had a sensitivity and PPV of 83.02 and 100%, respectively. Using both together, the sensitivity and PPV were 83.02 and 81.48%, respectively; and these criteria classified 18 women with normal carbohydrate metabolism as having abnormal carbohydrate metabolism. "In summary, the A1C test significantly underdiagnosed carbohydrate metabolism disorders in women who had had GDM," the authors write. Continue reading >>

Utilizing A Diabetes Risk Test And A1c Point-of-care Instrument To Identify Increased Risk For Diabetes In An Educational Dental Hygiene Setting

Utilizing A Diabetes Risk Test And A1c Point-of-care Instrument To Identify Increased Risk For Diabetes In An Educational Dental Hygiene Setting

Purpose: The objective of this pilot study was to demonstrate the number of patients at increased risk for type 2 diabetes development using a validated survey; and to assess the rate of compliance for A1c screening in an educational dental hygiene setting. Methods: This was a descriptive study using a purposive sample of patients in an academic dental hygiene clinic, who were 18 years or older, not diagnosed with prediabetes or type 2 diabetes. Utilizing the American Diabetes Association adopted diabetes risk survey, patients determined to be at increased risk for type 2 diabetes were offered the opportunity for further assessment by having their A1c tested using a point of care instrument. Patients demonstrating an increased risk for prediabetes or type 2 diabetes, with either the survey or the point of care instrument, were referred to their primary physician for further evaluation. Results: A total 179 of the 422 solicited patients agreed to participate in the American Diabetes Association adopted diabetes risk survey. According to the survey guidelines, 77 participants were considered increased risk for type 2 diabetes for an at-risk prevalence of 48% (95% Confidence Interval (CI): 40 to 56%). The at-risk participants were then asked to have an A1c test of which 45 agreed (compliance rate 58%, 95% CI: 47 to 70%). Using American Diabetes Association A1c parameters, 60.98% (n=25) indicated a prediabetes (5.7 to 6.4%) range, and 4.88% (n=2) indicated a diabetes (6.5%) range. Conclusion: Utilizing the American Diabetes Association adopted diabetes risk survey in any dental setting could provide patients with invaluable health information, and potentially improve overall health outcomes. A systematic analysis of the global prevalence of type 2 diabetes found the number Continue reading >>

The Endocrine Society Statement On The Use Of A1c For Diabetes Diagnosis And Risk Estimation

The Endocrine Society Statement On The Use Of A1c For Diabetes Diagnosis And Risk Estimation

8401 CONNECTIC AVENUE, SUITE 900 CHEVY CHASE, MARYLAND 20815-5817 TELEPHONE 301.941.0200 FAX 301.941.0259 www.endo-society.org UT January, 2010—The recently published Clinical Practice Recommendations of the American Diabetes Association (ADA)1 have taken a major new step in advocating the use of the A1C test for the diagnosis of diabetes, and for the identification of patients at risk for diabetes. The new recommendations indicate that patients with an A1C of 6.5% or higher can be identified as having diabetes without the need for a different confirmatory test, and patients with A1C 5.7%-6.4% can be considered as being at risk for the development of diabetes (a condition previously referred to as pre-diabetes). Before this statement, the only acceptable tests for the diagnosis of diabetes in non- pregnant adults were plasma glucose levels (≥126 mg/dL fasting, ≥200 mg/dL randomly obtained with symptoms of diabetes, and ≥200 mg/dL after an oral glucose tolerance test). The use of A1C for screening and diagnosis of patients with diabetes offers some distinct advantages for patients and caregivers. It does not require sampling patients after an overnight fast or two hours after the administration of oral glucose. Although the ADA is recommending the use of this test as an alternative to the previously-used measures of fasting plasma glucose and two hour oral glucose tolerance test, it is likely that A1C will replace these other tests in most cases because of its ease of use. The rationale for the use of A1C for diagnostic purposes is largely based upon data showing that the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy) tend to occur or already have occurred in patients with A1C ≥6.5%. The population-based Continue reading >>

Aap Updates Schedule Of Screening And Assessments For Well-child Visits

Aap Updates Schedule Of Screening And Assessments For Well-child Visits

AAP Updates Schedule of Screening and Assessments for Well-Child Visits 2/24/2014 For Release: February 24, 2014 The American Academy of Pediatrics (AAP) has updated its schedule of the screenings and health assessments that are recommended at each well-child visit from infancy through adolescence. The updated periodicity schedule reflects current AAP recommendations for preventive pediatric health care, which are explained in detail in the third edition of Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents. Under the Affordable Care Act, non-grandfathered health plans are required to cover services that are recommended by Bright Futures (and included in the periodicity schedule), with no cost sharing. Information was added about a specific screening tool to assess adolescents for alcohol and drug use. Screening for depression at ages 11 through 21 years has been added, along with suggested screening tools. Cholesterol screening between ages 9 and 11 years was added. A risk assessment for hematocrit or hemoglobin at ages 15 and 30 months was added. Screening for HIV was added between age 16 and 18 years. Adolescents should no longer be routinely screened for cervical dysplasia until age 21. Newborns should be screened for critical congenital heart disease using pulse oximetry before leaving the hospital. The schedule is published in the March 2014 Pediatrics (published online Feb. 24). Future updates to the schedule will be made online periodically. The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www Continue reading >>

Diabetes

Diabetes

Diabetes mellitus is one of the most common chronic diseases among American adults. These expenditures can be attributed to long-term complications resulting from diabetes. Some of the most significant long-term complications include blindness, renal failure and diffuse cardiovascular disease. Controlling diabetes is now a more attainable goal because of the increased availability of effective medications and insulin regimens. In an effort to facilitate better diabetes control, national medical organizations such as the American Medical Association and the American Academy of Family Physicians establish guidelines for the standard of care for diabetes. To date, such standards of care for the diabetic patient include: regular glycosylated hemoglobin testing (A1C), annual fasting lipid profiles, regular urine testing for microalbuminuria and blood pressure control targets of under 140/90. The following indicators provide performance minimums for the quality of care delivered to diabetic patients in Arkansas and across our nation: Preventive health partnership health card kit The American Cancer Society, American Diabetes Association and American Heart Association created a “health test card” designed for use in a clinical setting to facilitate communication between a patient and a provider about recommended health tests and to increase the number of people being screened for chronic diseases. Each kit contains male and female health test cards, an interactive piece intended to be used in a clinical setting to facilitate an exchange between a patient and a provider in an effort to: 1) increase a patient’s knowledge of appropriate screenings; 2) increase the public’s understanding about the clinical role for prevention; and 3) increase the number of people being scr Continue reading >>

Screening For Type 2 Diabetes Mellitus

Screening For Type 2 Diabetes Mellitus

INTRODUCTION Diabetes is one of the major causes of early illness and death worldwide. Type 2 diabetes affects approximately 8 percent of the United States population, with as many as 25 to 40 percent of those with diabetes undiagnosed [1,2]. Worldwide, the prevalence of type 2 diabetes is estimated at 6.4 percent in adults, varying from 3.8 to 10.2 percent by region; rates of undetected diabetes may be as high as 50 percent in some areas [3,4]. Type 2 diabetes accounts for over 90 percent of patients with diabetes. Because of the associated microvascular and macrovascular disease, diabetes accounts for almost 14 percent of United States health care expenditures, at least one-half of which are related to complications such as myocardial infarction, stroke, end-stage renal disease, retinopathy, and foot ulcers [5]. Numerous other factors also contribute to the impact of diabetes on quality of life and economics. Diabetes is associated with a high prevalence of affective illness [6] and adversely impacts employment, absenteeism, and work productivity [7]. This topic will discuss the evidence and recommendations related to screening asymptomatic patients for type 2 diabetes mellitus. Screening pregnant women for gestational diabetes and the evaluation of patients with signs and symptoms of diabetes (polydipsia, polyuria, blurred vision, paresthesias, or unexplained weight loss) is discussed separately. Additionally, the prevention of type 2 diabetes in patients with impaired glucose tolerance (IGT) is discussed separately. (See "Diabetes mellitus in pregnancy: Screening and diagnosis" and "Clinical presentation and diagnosis of diabetes mellitus in adults" and "Prevention of type 2 diabetes mellitus".) RATIONALE FOR SCREENING The following five criteria define the optimal Continue reading >>

Update On Diabetes Diagnosis: A Historical Review Of The Dilemma Of The Diagnostic Utility Of Glycohemoglobin A1c And A Proposal For A Combined Glucose-a1c Diagnostic Method

Update On Diabetes Diagnosis: A Historical Review Of The Dilemma Of The Diagnostic Utility Of Glycohemoglobin A1c And A Proposal For A Combined Glucose-a1c Diagnostic Method

From the Department of Medicine, Michigan State University, College of Human Medicine East Lansing, Michigan, USA How to cite this article: Aldasouqi SA, Gossain VV. Update on Diabetes Diagnosis: A Historical Review of the Dilemma of the Diagnostic Utility of Glycohemoglobin A1c and a Proposal for a Combined Glucose-A1c Diagnostic Method. Ann Saudi Med 2012;32(3):229-235. The role of glycohemoglobin A1c (A1c) for the diagnosis of diabetes has been debated for over three decades. Recently, the American Diabetes Association (ADA) has recommended adding A1c as an additional criterion for diabetes diagnosis. In view of the continued debate about the diagnostic utility of A1c, and in view of the unabated burden of undiagnosed diabetes, the search for alternative diagnostic methods is discussed. A historical literature review is provided, in view of the new ADA diagnostic guidelines, and a proposal is provided for combining A1c and a glucose measurement as a diagnostic alternative/adjunct to the use of a single criterion. This proposal is based on the non-overlapping of the advantages and disadvantages of these individual tests. The cost-effectiveness of this method remains to be tested. The American Diabetes Association (ADA) has now acknowledged1 glycohemoglobin A1c (A1c) as a diagnostic criterion for diabetes mellitus, for the first time since the publication of the ADA’s first diagnostic guidelines in July of 1997.2 Thus, the current (revised) ADA’s criteria for diabetes diagnosis and screening, as of January of 2010, are: 1) A1c ≥6.5%; or 2) Fasting plasma glucose (FPG) ≥126 mg/dL (fasting > 8hours); or 3) 2-hour glucose per 75 g oral glucose tolerance test (OGTT) ≥200 mg/dL, according to the World Health Organization (WHO) protocol; or 4) Random glucose (with Continue reading >>

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