Must read if you’re an underwriter. Here.
The new study included 9,000 adults without a diabetes diagnosis. The participants got both an A1c test and an oral tolerance glucose test, and the researchers compared the results. The researchers found the A1c test didn’t catch 73 percent of diabetes cases that were detected by the oral glucose test. “The A1c test said these people had normal glucose levels when they didn’t,” Chang Villacreses said.
CONCLUSIONS An HbA1c >8.0% was associated with increased risk of all-cause and cause-specific mortality in older adults with diabetes. Our results support the idea that better glycemic control is important for reducing mortality; however, in light of the conflicting evidence base, there is also a need for individualized glycemic targets for older adults with diabetes depending on their demographics, duration of diabetes, and existing comorbidities.
Source: Diabetes Care
RESULTS – During long-term follow-up of children and adolescents who did not initially have diabetes, the incidence rate of subsequent diabetes was fourfold (in boys) as high and more than sevenfold (in girls) as high in those with HbA1c ≥5.7% as in those with HbA1c ≤5.3%—greater rate ratios than experienced by adults in the same HbA1c categories. Analyses of ROCs revealed no significant differences between HbA1c, FPG, and 2hPG in sensitivity and specificity for identifying children and adolescents who later developed diabetes. CONCLUSIONS – HbA1c is a useful predictor of diabetes risk in children and can be used to identify prediabetes in children with other type 2 diabetes risk factors with the same predictive value as FPG and 2hPG.
Source: Diabetes Care
Reprinted from Johns Hopkins Health Alert Email
A reader asks, “I’m 72 and my HbA1c level is usually around 8.0 percent, which my doctor says is fine. Should I be taking medication to get it below 7.0 percent?” Here’s our answer.
Not necessarily. Striving for an HbA1c level below 7.0 percent is the goal for many nonpregnant adults with diabetes. However, less aggressive goals may be appropriate for certain groups of patients, including older adults with multiple comorbidities or decreased functional status, or who are at high risk for hypoglycemia.
It remains unclear the degree to which “tight control” benefits older adults given that earlier studies of intensive glucose control in diabetes excluded elderly patients. Indeed, tight control may cause harm, such as hypoglycemia and potentially higher mortality, as suggested in recent studies of older individuals — for example, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.
Current advice. The American Geriatrics Society advises adults over 65 who are healthy to aim for an HbA1c between 7.0 and 7.5 percent. If your life expectancy is less than 10 years and you have other chronic conditions, such as heart or kidney disease, a goal of 7.5 to 8.0 percent might be appropriate.
For those with a shorter life expectancy who are being treated for multiple medical conditions, an HbA1c of 8.0 to 9.0 may be reasonable.
However, otherwise healthy and robust older adults may benefit from glycemic targets similar to those recommended for younger adults (HbA1c less than 7 percent). In general, goals of care should be individualized for each patient.
High HbA1c levels were associated with increased risk for all-cause mortality and death from CVD, coronary heart disease, and cerebral infarction in general East Asian populations, as in Western populations.
via HbA1c and the Risks for All-Cause and Cardiovascular Mortality in the General Japanese Population.
Glucose-Independent, Black–White Differences in Hemoglobin A1c Levels — Ann Intern Med
Remember, we do not use race in our underwriting.
Newer Blood Test Predicts Diabetes, Heart Disease – BusinessWeek
For the current study, Selvin and her colleagues measured A1C from more than 11,000 stored blood samples from the Atherosclerosis Risk in Communities Study, which began in 1990. None of the study volunteers had diabetes or cardiovascular disease at the time the blood samples were taken.
The researchers then compared the A1C levels to fasting blood sugar levels and to the 15 years of overall health follow-up information gathered for the previous study.
During that time, 2,251 people were diagnosed with diabetes, nearly 1,200 were diagnosed with heart disease and 358 people had an ischemic (non-bleeding) stroke, according to the study.
As expected, the researchers found that elevated A1C levels were associated with an increased risk of being diagnosed with diabetes. Those with an A1C of less than 5 percent had a 48 percent reduced risk of diabetes, while people whose A1Cs were between 5 and 5.5 percent had a normal risk of diabetes. From there, however, the risk quickly went up. Those with an A1C of 5.5 to 6 percent had an 86 percent increased risk of diabetes. For those between 6 and 6.5 percent, the risk more than quadrupled. For people with levels above 6.5 percent, the odds of being diagnosed were more than 16 times higher than for someone with levels under 5.5 percent. These results were similar to those for fasting glucose levels, the study authors noted.
Where fasting glucose and A1C differed greatly, however, was in the prediction of future heart disease and stroke risk. While fasting glucose failed to predict future risk, the study found that A1C levels accurately did so.
People with A1Cs under 5.5 percent had an average risk of heart disease and stroke, but for people with an A1C between 5.5 and 6 percent, the risk went up 23 percent. For those with an A1C between 6 and 6.5 percent, the risk of cardiovascular disease jumped to 78 percent. When A1C went over 6.5 percent, the risk of cardiovascular disease went up nearly twofold.
Results of the study are published in the March 4 issue of the New England Journal of Medicine.
Cardiovascular Disease, Neuropathy, and Retinopathy — Diabetes Care
In a study of 648 apparently healthy individuals, 12% had an elevated total A 1 level (measured in that study) not explained by measurement error or glucose intolerance and remaining in the same range over 3.5 years in 90% of those initially with high and in 68% of those initially with low baseline levels (1). There was no correlation with glucose tolerance, with caloric intake, or with physical activity, but A 1 level was associated with cigarette use and with clinically overt atherosclerosis, leading Dekker to conclude that “factors unrelated to glucose metabolism are the main determinants of A 1” in nondiabetic individuals, perhaps with bearing on risk of what are considered complications of diabetes.
