A simple test that measures long-term blood sugar may help identify millions of people with undiagnosed type 2 diabetes.
The test, known as hemoglobin A1c (HbA1c), provides information on a person's average blood sugar (glucose) over the past 2 to 3 months and does not require fasting. Although the fasting plasma glucose test is still considered the most accurate measure, HbA1c may be more pragmatic because it does not require patients to fast for several hours beforehand.
More than 5 million Americans have undiagnosed diabetes.
If not controlled, the disease can lead to serious medical complications such as heart disease, blindness, kidney damage and amputations resulting from damage to nerves.
Currently, however, there is no clear evidence to support widespread screening at the doctor's office. While the new findings do not show that the HbA1c test is a cost-effective way to do routine screening, they do suggest that more cases of diabetes can be caught.
The test was particularly effective at detecting new cases of diabetes in obese individuals, those with high blood pressure and individuals with a family history of the disease.
An estimated 16 million Americans have been diagnosed with type 2 diabetes, but medical experts say the figure is actually higher.
Journal of General Internal Medicine January 2002;17:1-7
I routinely perform the hemoglobin A1c test in diabetics, but I have not found it as useful, or even as sensitive, as another wonderful screen for diabetes, which is the fasting glucose and insulin test.
The absolute best test for diagnosing diabetes truly remains the eight-hour fasting blood sugar. It is absolutely amazing how powerful and sensitive this test is.
The ideal fasting blood glucose should be around 87. I become nervous when my patients have numbers over 100. Traditional standards state that diabetes is formally diagnosed at 120.
With insulin levels, the lower the better. I like to see them below 5, but 2 or 3 would be far better. Any fasting insulin level over 10 is a major problem and is a huge risk factor for diabetes.
Fortunately, diabetes can be treated and prevented. Here is a three-step plan that should help you gain control over your diabetes if you have it, and protect you from getting it if you don't.
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