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Hemoglobin A1c 5.9 Percent

Clinical Study Elevated Hemoglobin A1c And Low-density Lipoprotein Cholesterol Levels In Thiazide-treated Diabetic Patients☆

Clinical Study Elevated Hemoglobin A1c And Low-density Lipoprotein Cholesterol Levels In Thiazide-treated Diabetic Patients☆

Abstract Despite the well-known hyperglycemic effect of thiazide diuretics, these agents are often administered to diabetic patients. This study compared 89 insulin-treated diabetic patients receiving hydrochlorothiazide, 57 receiving furosemide, and 255 receiving no diuretic. Hemoglobin A1c level was 7.2 ± 1.8 percent (mean ± SD) with hydrochlorothlazide, significantly higher than the levels of 5.9 ± 2.3 percent with furosemide and 6.4 ± 2.0 percent with no diuretic. Low-density lipoprotein cholesterol level was 154 ± 43 mg/dl with hydrochlorothiazide, but 134 ± 42 mg/dl with furosemide and 130 ± 42 mg/dl with no diuretic. Multivariate analysis showed that the associations remained significant after adjustment for age, sex, race, type and duration of diabetes, body mass index, blood pressure, serum potassium level, insulin dose, and treatment with other medications. These findings suggest that treatment with thiazide diuretics in the diabetic population may increase low-density lipoprotein cholesterol and hemoglobin A1c levels. ☆ This work was supported in part by grants from the Mount Sinai Hospital, Auxiliary Fund, New York, New York, the New York State Bureau of Health, Albany, New York, the Centers for Disease Control, Atlanta, Georgia, and the Alexander Foundation, New York, New York. 1 From the Division of Arterosclerosis and Metabolism, Department of Medicine, and the Division of Pediatric Endocrinology and Metabolism, Mount Sinai Medical Center, New York, New York. Continue reading >>

A1c Of 5.8 Percent In Children A Better Diagnostic Target To Diagnose Diabetes

A1c Of 5.8 Percent In Children A Better Diagnostic Target To Diagnose Diabetes

Utility of A1c of 6.5% for diagnosing pre–diabetes and diabetes in obese, questioned.… Hemoglobin 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. Researchers 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. At baseline, subjects were stratfied 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 classfied with pre-diabetes 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. In a large clinic based multiethnic cohort of obese children and adolescents, regardless of age and sex, an A1c of 6.5% had relatively low sensitivity and specificity for classifying Type 2 diabetes. There was poor agreement between A1c and OGTT criteria in classifying subjects with Continue reading >>

Life Extension Update

Life Extension Update

The August, 2008 issue of the European Journal of Clinical Nutrition published the discovery of researchers in Japan that supplementing the diet with green tea extract improves fasting hemoglobin A1c, a blood marker that is regularly tested in diabetics to assess long term glucose control. While fasting glucose provides an immediate measurement of blood glucose levels, hemoglobin A1c assesses glycation, a process that occurs when blood sugar molecules bind with proteins such as hemoglobin. The excessive glycation that occurs in people with consistently elevated blood sugar results in damaged tissues, which contributes to the apparent accelerated aging observed in diabetic patients. High hemoglobin A1c levels indicate elevated average glucose levels over the three month period prior to testing. For the current crossover study, researchers at the University of Shizuoka, Osaka University, and Hamamatsu University School of Medicine in Japan enrolled 49 men and 11 women with prediabetes. An early intervention group consisting of 29 participants received a daily green tea extract powder containing 544 milligrams polyphenols (providing 456 milligrams catechins) for two months, followed by two months during which no supplement was received. The participants in the later intervention group received no supplement for the first two months, followed by two months of daily green tea supplementation. Fasting hemoglobin A1c levels were measured at the beginning of the study and at two and four months. For both groups, fasting hemoglobin A1c levels were found to be significantly reduced from baseline levels following green tea supplementation. Hemoglobin A1c levels declined from 6.2 to 5.9 percent in the early intervention group, and from 6.1 to 5.9 percent in the later intervention g Continue reading >>

Hba1c More Than 5.9 Percent Can Id Diabetes In Early Pregnancy

Hba1c More Than 5.9 Percent Can Id Diabetes In Early Pregnancy

(HealthDay)—An HbA1c threshold of ≥5.9 percent can identify all women with gestational diabetes in early pregnancy, according to a study published online Sept. 4 in Diabetes Care. Ruth C.E. Hughes, M.B.B.Ch., from the University of Otago in New Zealand, and colleagues analyzed data from a group of women who completed an early oral glucose tolerance test (OGTT) and HbA1c tests. Pregnancy outcome data were also assessed. In 16,122 women, HbA1c was measured at a median of 47 days' gestation. Twenty-three percent of those offered (974 women) took an early OGTT, and in this subset all 15 cases of diabetes were identified with HbA1c ≥5.9 percent. For gestational diabetes mellitus before 20 weeks this threshold was 98.4 percent specific (positive predictive value, 52.9 percent). Excluding the women referred for gestational diabetes, women with HbA1c of 5.9 to 6.4 percent had poorer pregnancy outcomes than those with HbA1c <5.9 percent (8,174 women): relative risk of major congenital anomaly was 2.67; pre-eclampsia, 2.42; shoulder dystocia, 2.47; and perinatal death, 3.96. "HbA1c measurements were readily performed in contrast to the low uptake of early OGTTs," the authors write. Continue reading >>

Guide To Hba1c

Guide To Hba1c

Tweet HbA1c is a term commonly used in relation to diabetes. This guide explains what HbA1c is, how it differs from blood glucose levels and how it's used for diagnosing diabetes. What is HbA1c? The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. HbA1c is also referred to as haemoglobin A1c or simply A1c. HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration. How does HBA1c return an accurate average measurement of average blood glucose? When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why peop Continue reading >>

As Metformin Combinations Proliferate, Questions Arise About Value

As Metformin Combinations Proliferate, Questions Arise About Value

For some patients newly diagnosed with type 2 diabetes, skipping metformin monotherapy and going straight to fixed-dose combinations with a DPP-4 inhibitor or an SGLT2 inhibitor makes sense, evidence shows. Earlier this year, when the FDA granted initial approval to Jentadueto XR and a first-line indication to Invokamet, it gave fresh momentum to an entire category of medications: single pills that combine metformin with some other treatment for type 2 diabetes (T2D). Several recent studies suggest that physicians should employ combination therapy faster and more aggressively than they have in the past. Indeed, a growing body of evidence supports immediate combination therapy for many patients. There are questions, however, about the benefits of physically combining medications. Studies show that fixed-dose combinations do improve patient adherence to treatment regimens. There is less evidence, however, that patients fare better over time with combination pills rather than their component pills. Although a number of payers declined requests from Evidence-Based Diabetes Management to discuss how much value they see in the physical combination of existing oral medications, their formularies suggest they see some. Most pharmacy benefits managers cover most combinations. “There’s some value in 1 pill instead of 2. We just don’t know exactly how much,” John Buse, MD, PhD, a professor at the University of North Carolina School of Medicine and the director of the university’s diabetes care center, told Evidence-Based Diabetes Management in an interview. No new trials were required for the approval of Jentadueto XR. The approval hinged on pre-existing validation of its method of delayed drug release and trial results from the immediate-release version of Jentadueto, w Continue reading >>

A1c Predicts Type 2 Diabetes And Impaired Glucose Tolerance In A Population At Risk: The Community Diabetes Prevention Project

A1c Predicts Type 2 Diabetes And Impaired Glucose Tolerance In A Population At Risk: The Community Diabetes Prevention Project

Abstract In a population at risk for type 2 diabetes (T2DM), we assessed early physical and metabolic markers that predict progression from normal to impaired glucose tolerance (IGT) and T2DM. A total of 388 individuals (22% male, age 46 + 11 years) at risk for T2DM were randomized to Standard (n = 182) or Intervention (n = 206) care and evaluated at baseline and 5 annual follow-up visits, including blood pressure, BMI, A1C, lipids, urine albumin/creatinine ratio, VO2max, fasting glucose, insulin and C-peptide. The Standard group received results of annual lab tests and quarterly newsletters, while the Intervention group received quarterly newsletters and detailed discussions of lab results, routine self-directed activities, semi-annual group meetings and monthly telephone calls for ongoing support. Overall, 359 (93%) returned for at least one follow-up visit and 272 (70%) completed the final 5-year assessment. Return rates, changes in measures and incidence of IGT/T2DM were similar between groups. Low cardiorespiratory fitness (VO2max) was the most prevalent baseline abnormality. A1C and BMI were significant predictors of IGT/T2DM after controlling for other factors. The risk of IGT/T2DM within 5 years was 17.16 (95% CL: 6.169, 47.736) times greater for those with baseline A1C>=5.8% as compared to those <5.8% (p < 0.0001). Baseline A1C>=5.8% was a significant predictor of IGT/T2DM within 5 years in a population at high risk for T2DM. A1C is routinely performed among patients with diabetes, however these data and other evidence suggest that it may also be a useful tool for risk assessment and screening. Introduction Diabetes is a chronic disease affecting 171 million of people in the world [1]. The total cost of care for diabetes and its associated complications in 2002 Continue reading >>

Mandatory Reporting Of Noncommunicable Diseases: The Example Of The New York City A1c Registry (nycar)

Mandatory Reporting Of Noncommunicable Diseases: The Example Of The New York City A1c Registry (nycar)

Diabetes imposes a major public health burden on patients and the health care system. Today, 21 million Americans have diabetes, and an estimated 6 million of them are unaware of it [1]. One in three people born in the United States in 2000 will develop diabetes at some point in their lives [2]. In New York City, 500,000 people have diabetes, corresponding to an overall prevalence of 8 percent, ranging from 5.9 percent in Manhattan to 10.9 percent in the Bronx [3]. Understand why proponents of the New York public health department's mandatory reporting and registry of individuals with poor glycemic control believe that its benefits outweigh the potential for invasion of patients' privacy. Complications of diabetes include heart disease, stroke, kidney failure, blindness, and lower extremity amputations. Nationwide, diabetes is the sixth leading cause of mortality [1]. Large-scale efficacy studies show that tight control of HbA1c (that is, the component of hemoglobin to which glucose is bound) produces a 20 to 50 percent reduction in microvascular complications [4]. Unfortunately, tight control (HbA1c < 7 percent) has been hard to achieve: 28 percent of New York City (NYC) patients with commercial insurance and 37 percent of those with Medicaid have "poor control" (A1c >9 percent) [5]. In fact, only 10 percent of patients even know what their A1c measurements are [6]. As more and more people are diagnosed, the cost of diabetes increases, both in dollars required to provide care and in hours devoted to care by health care professionals. The Centers for Disease Control and Prevention estimated in 2002 that the U.S. spent at least $132 billion annually on diabetes [1]. The New York City A1c Registry (NYCAR) To help combat the rising incidence of type 2 diabetes, NYC's Depar Continue reading >>

How To Calculate Your A1c

How To Calculate Your A1c

The Hemoglobin A1c (HbA1c or simply A1c for short) test is a blood test used to measure the average blood glucose concentration in your body in the past 1-3 months. For diabetics, this is the standard way of determining how well the diabetes is controlled. An A1c of less than 7% is considered good. Getting the test every 3 months (usually during a doctor visit) is usually enough. But sometimes you may want to just estimate your A1c level based on the data from your regular self-tests. The formula below could help in this case. Accuracy, of course, could vary depending on how often and when you check your blood sugar. I found it pretty accurate last time I used it. My calculation was off only by 0.1%. This is the same formula GlucoseTracker uses in the app's dashboard. Glucose in mg/dL: A1c = (46.7 + average_blood_glucose) / 28.7 Glucose in mmol/L: A1c = (2.59 + average_blood_glucose) / 1.59 So, for example, if your average blood glucose level in the past 3 months is 130 mg/dL (7.2 mmol/L) , your estimated A1c is 6.15%. There are also cheaper devices you can buy that will allow you to do the actual A1c tests yourself, like this one. If you need to do these tests more often, say every month, then it could save you money in the long run as lab tests could get expensive. It may not be as accurate as the lab tests, but my guess is it's probably good enough. Continue reading >>

Non-fasting Test Is New Standard For Diabetics

Non-fasting Test Is New Standard For Diabetics

Chapel Hill, N.C. — Many people go through health screenings that include a fasting blood test, which is used to find people at-risk for diabetes and to monitor those with the disease. Now, a more accurate, non-fasting test – called the Hemoglobin A1c – is the new standard. “The fasting glucose test is like a snapshot on diabetes, but the A1c is a short movie – looking at blood sugar over two to three months,” said UNC endocrinologist Dr. John Buse. Buse says the test looks at the amount of sugar stuck to hemoglobin molecules. “It lives inside the red blood cell, which has a lifespan of about two to three months,” he said. The American Diabetes Association now recommends the A1c test be the standard for diabetes screening. For diabetics, the results show a number of 6.5 or higher. In screening, a number below 5.7 is normal and between 5.7 and 6.5 is high risk. To avoid Type 2 diabetes, a doctor might recommend diet and exercise. “There's a good chance you can bring that A1c test down and avoid being diagnosed with diabetes,” Buse said. Buse says about 60 percent of Type 2 diabetes cases could be prevented with a low-fat, low-sugar diet and regular exercise if those people are identified early. Continue reading >>

A1c Level And Future Risk Of Diabetes: A Systematic Review

A1c Level And Future Risk Of Diabetes: A Systematic Review

Go to: RESEARCH DESIGN AND METHODS Data sources We developed a systematic review protocol using the Cochrane Collaboration's methods (9). We formulated search strategies using an iterative process that involved medical subject headings and key search terms including hemoglobin A, glycated, predictive value of tests, prospective studies, and related terms (available from the authors on request). We searched the following databases between database establishment and August 2009: MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science (WOS), and The Cochrane Library. Systematic searches were performed for relevant reviews of A1C as a predictor of incident diabetes. Reference lists of all the included studies and relevant reviews were examined for additional citations. We attempted to contact authors of original studies if their data were unclear or missing. Study selection and data abstraction We searched for published, English language, prospective cohort studies that used A1C to predict the progression to diabetes among those aged ≥18 years. We included studies with any design that measured A1C—whether using a cutoff point or categories—and incident diabetes. Titles and abstracts were screened for studies that potentially met inclusion criteria, and relevant full text articles were retrieved. X.Z. and W.T. reviewed each article for inclusion and abstracted, reviewed, and verified the data using a standardized abstraction template. If A1C measurement was standardized by the National Glycohemoglobin Standardization Program (NGSP) and both standardized and unstandardized A1C values were reported, standardized values were used in the analyses. A sensitivity analysis, however, was conducted using both standardized and unsta Continue reading >>

Normal, High, And Low Hemoglobin A1c Levels

Normal, High, And Low Hemoglobin A1c Levels

On the other hand, as the RBC circulates, it combines its HbA1 with some of the glucose in the bloodstream to form glycohemoglobin (GHb). The amount of GHb depends on the amount of glucose available in the bloodstream over the RBC’s 120-day life span. Therefore determination of the GHb value reflects the average blood sugar level for the 100- to 120-day period before the test. The more glucose the RBC is exposed to, the greater the GHb percentage. One important advantage of this test is that the sample can be drawn at any time, because it is not affected by short-term variations (e.g., food intake, exercise, stress, hypoglycemic agents, patient cooperation). It is also possible for very high short-term blood glucose levels to cause an elevation of GHb. Usually, however, the degree of glucose elevation results not from a transient high level but from a persistent, moderate elevation over the entire life of the RBC. Continue reading >>

The Abcs Of Diabetes: A1c, Blood Pressure, And Cholesterol

The Abcs Of Diabetes: A1c, Blood Pressure, And Cholesterol

Three important diabetes measures There is so much to think about when you have diabetes, but this easy-to-remember acronym will help you focus on what’s important and take control of your health. Read our breakdown and talk to your doctor about what’s right for you. A = AIC What is it? An A1C blood test measures the percentage of hemoglobin (the oxygen-carrying protein in your red blood cells) coated with sugar. It measures your average blood glucose (sugar) level over the past two to three months. The A1C test gives you and your health care provider a measure of your progress. Most people with diabetes should have an A1C test every three to six months; people who are meeting their treatment goals may need the test only twice a year. Why is it important? The A1C test is a good measure of how well your glucose is under control. It can also be a good tool for determining if someone with prediabetes is progressing toward or has developed type 2 diabetes. Adults over age 45 with hypertension, obesity, or a family history of diabetes also are advised to get an A1C test because they have a greater risk of developing type 2 diabetes. Finding out you have an elevated A1C is a cue to make positive changes to your lifestyle. What do the numbers mean? 5.7% or lower = normal blood glucose levels 5.8–6.4% = elevated blood glucose levels (prediabetes) 6.5% or higher = diabetes What should my numbers be? For years, people with type 2 were told to strive for an A1C of 7 percent or less, but new research indicates that one level doesn’t fit all. Based on your health status, age, and risk factors, you and your health care provider should determine an A1C goal for you. Here are the American Diabetes Association’s new general guidelines: Person newly diagnosed with type 2 diabet Continue reading >>

Da - The Effects Of Uncontrolled Diabetes And More.

Da - The Effects Of Uncontrolled Diabetes And More.

Diabetes In America The number of Americans with diabetes continues to increase, according to CDC's most recent National Diabetes Fact Sheet. So does the number of Americans with prediabetes, a condition that increases their risk of type 2 diabetes, heart disease, stroke, kidney disease, foot complications or Neuropathy, eye complications, skin complications, depression and gingivitis disease or tooth and bone loss. States with the largest increases over the 16-year period were Oklahoma, up 226 percent; Kentucky, up 158 percent; Georgia, up 145 percent; Alabama, up 140 percent, Washington, up 135 percent, and West Virginia, up 131 percent, according to the study published in CDC's Morbidity and Mortality Weekly Report. Beta cells, which are found in the pancreas within tiny cell clusters called islets, are the body’s sole source of the essential hormone insulin. Diabetes is characterized by the bodies in ability to produce and/ or respond appropriately to insulin, and results in the inability of the body to absorb and use glucose as a cellular fuel. These defects result in a persistent elevation of blood glucose levels and other metabolic abnormalities, which, in turn, lead to the development of disease complications. The most common forms of diabetes are Type I diabetes, in which the immune system launches a misguided attack, destroying the beta cells of the pancreas, and Type 2 diabetes, in which the body becomes resistant to insulin signaling, with subsequent impaired insulin production. While the causes of beta cell loss or failure differ, all major forms of diabetes share a common bond in the pancreatic beta cell. This is particularly important in light of studies that show that adverse changes in both the micro- and macro vascular environments can occur up to 10 Continue reading >>

What Is The A1c Test? How Does A1c Relate To Blood Glucose?

What Is The A1c Test? How Does A1c Relate To Blood Glucose?

Anyone with diabetes will be familiar with finger-prick testing for monitoring blood glucose to see how well they are managing their disease. This kind of regular testing is essential for most people with diabetes, but what role does an occasional hemoglobin A1C blood test play in controlling blood sugars, and how does it work? Contents of this article: What is the A1C test? The abbreviation A1C is used in the US (sometimes with a lower-case 'c' - A1c) and is short for glycated hemoglobin (sometimes called 'glycosylated' hemoglobin or glycohemoglobin). The other abbreviations in use are: HbA1c (widely used internationally) HbA1c Hb1c HgbA1C. The A1C test is a blood test used to measure the average level of glucose in the blood over the last two to three months. This test is used to check how well blood sugar levels are being controlled in a person with diabetes and can also be used in the diagnosis of diabetes.1 Hemoglobin is the protein in red blood cells which is responsible for transporting oxygen around the body. When blood glucose levels are elevated, some of the glucose binds to hemoglobin and, as red blood cells typically have a lifespan of 120 days, A1C (glycated hemoglobin) is a useful test because it offers an indication of longer term blood glucose levels.2 The particular type of hemoglobin that glucose attaches to is hemoglobin A, and the combined result is call glycated hemoglobin. As blood glucose levels rise, more glycated hemoglobin forms, and it persists for the lifespan of red blood cells, about four months.2 Therefore, the A1C level directly correlates to the average blood glucose level over the previous 8-12 weeks; A1C is a reliable test that has been refined and standardized using clinical trial data.3 There are two key things to know about the appl Continue reading >>

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