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Critical Diabetes Test - A1C - Proven to be Accurate Average Glucose
FOR IMMEDIATE RELEASE A1C Translation to Estimated Average Glucose (eAG) Units Will Yield Easier Patient Education San Francisco, CA (June 7, 2008) -- A mathematical relationship between
the average glucose level over the preceding three months and levels of the
A1C test, thus yielding translation of the A1C for reporting as estimated average
glucose (eAG), was proven in an international study published online today in
the August issue of Diabetes Care. A1C has been used for more than 25 years
as the major measure of glucose control and to establish targets for diabetes
therapy.
The implications of using eAG in mg/dl or mmol/L – the same units that patients use for self-monitoring of blood glucose (SMBG) at home – were discussed recently by his co-chair, Robert J. Heine, MD, PhD, Professor of Diabetology in the Department of Endocrinology at the VU University Medical Center in Amsterdam, Netherlands, and Executive Medical Director of the Diabetes and Endocrine Division of Eli Lilly and Company.
With A1C translated from a difficult-to-understand chemical entity into an easy-to-understand value that relates to the patient's every day home glucose monitoring, Dr. Heine predicts that eAG will prove to be a valuable education tool.
Checking Blood Glucose Levels People check their diabetes control at home by SMBG, usually by pricking their fingers for a blood sample and getting a reading using a simple monitor. Frequency varies depending on the type of diabetes and whether insulin injections are being used. Many people with type 1 diabetes, who must use insulin, do SMBG several times a day, or use continuous glucose monitors, which automatically check levels as often as every few minutes. The test provides information on blood glucose only at that moment. In contrast, A1C testing is a measure of glucose control over the prior 2-3 months. The test measures the amount of glucose that has attached to a portion of the hemoglobin molecule in the blood. It is reported as the percent of hemoglobin molecules that has glucose attached. The American Diabetes Association recommends a goal of less than 7%. It is also known as glycated hemoglobin testing. The International A1C-Derived Average Glucose Study A group of international investigators conducted a 10-center study to try to define, as accurately as possible, the relationship between average blood glucose levels and A1C. The study recruited 507 volunteers of various races and ethnicities: 268 type 1, 152 type 2, and 80 without diabetes. The study measured A1Cs in a central laboratory monthly for 3 months, and measured average glucose levels using a combination of continuous glucose monitoring and frequent self-monitoring of blood glucose levels. "We developed an equation that can be interpreted accurately as an estimated average glucose level by comparing the measurement of A1C with the average glucose levels,"explained Edward S. Horton, MD, Professor of Medicine, Harvard Medical School, and a co-author of the ADAG study, who will be presenting further information about the study at the American Diabetes Association's Scientific Sessions here tomorrow. Study investigators found a simple linear relationship. "Although the tight and consistent relationship across different subgroups
suggest that, for most people, there are no important factors that affect the
relationship between A1C and average glucose, the study does have some limitations,"said
Dr. Horton. In contrast to their intention and expectation, some ethnic-racial
groups were under-represented, particularly people of African and Asian descent.
Children and pregnant women were excluded from the study, as were patients who
were not in stable control or with any suggestion of red blood cell disorders.
So additional data in these groups would be needed to confirm the established
relationship. The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working together to conduct educational efforts to make both patients and providers aware of this new terminology, and help to understand the relationship between A1C and AG. In the meantime, the American Diabetes Association announced that physicians can visit its Web site at www.diabetes.org to purchase a very inexpensive handheld calculator that will provide an instant conversion of A1C values to eAG. Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation’s fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputation. For more information about diabetes, visit the American Diabetes Association Web site at www.diabetes.org or call 1-800-DIABETES (1-800-342-2383). Symposium Tuesday, 7:30 am PDT NOTE TO EDITOR: |
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