The American Diabetes Association (ADA) does not recommend use of the A1C test for diagnosis of diabetes. Instead, the fasting plasma glucose test should be used to diagnose diabetes in children and nonpregnant adults. The ADA recommends use of the A1C test as part of the initial assessment and in continuing care of people with diabetes. Physicians should perform the A1C test
- at least twice a year in patients who are meeting treatment goals and have stable glycemic control
- quarterly in patients not meeting treatment goals or when changes are made in therapy
In addition, point-of-care testing for A1C can help in making timely decisions about changes in therapy.
| Group | Target |
|---|---|
| Patients in general | Less than 7 percent |
| Individual patients | As close to normal as possible—less than 6 percent—without significant hypoglycemia |
| Patients with a history of severe hypoglycemia, those with limited life expectancies, very young children, older adults, and patients with comorbid conditions | Less stringent goals |
Effect of Hemoglobinopathies on A1C Test Results
With some assay methods, A1C tests in patients with hemoglobinopathies result in falsely high outcomes, overestimating actual average blood glucose levels for the previous 2 to 3 months. Physicians may then prescribe more aggressive treatments, resulting in increased episodes of hypoglycemia. Some assay methods used with some hemoglobinopathies may result in falsely low outcomes, leading to under-treatment of diabetes.
The A1C test is not recommended for diagnosis of diabetes in the general population because it is not sufficiently sensitive. Also important, in patients with hemoglobinopathies, results may be falsely elevated, so physicians may erroneously conclude a patient has diabetes. Confirmation with a fasting blood glucose is required for a diagnosis of diabetes to prevent inappropriate treatment decisions.
No comments:
Post a Comment