American Diabetes Association

The American Diabetes Association (ADA) released new recommendations for diagnosing diabetes. The association is promoting hemoglobin A1c (A1c) as a test that could reduce the number of undiagnosed patients.

The A1c test, which measures average blood glucose levels for a period of up to 3 months, was previously used only to evaluate long-term blood sugar control.

An A1c level of approximately 5% indicates the absence of diabetes. According to the revised guidelines, an A1c score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or higher indicates the presence of diabetes.

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For optimal diabetic control, the recommended ADA target for most people with diabetes is an A1c level no greater than 7%. However, we feel that tighter control is better.

Our experts agree that an A1c level less than 5.5% is possible if your diabetic diet includes a few key nutritional strategies.

It is hoped that achieving this target would help prevent serious diabetes-related complications including kidney disease, neuropathy, blindness, and heart disease.

Unlike fasting glucose testing, A1c testing does not require overnight fasting. Compliance with screening may therefore be improved through use of the A1c test, which can be determined from a single non-fasting blood sample.

What You Need to Know
The American Diabetes Association recommendations for 2010 emphasize early diagnosis and improvements in patient education.

Blood tests suggesting an increased risk for future diabetes now include an A1c range of 5.7% to 6.4%, as well as impaired fasting glucose and impaired glucose tolerance levels.

Revisions now include a discussion of possible future changes in this diagnosis, according to international consensus.

Screening recommendations for diabetes are to use risk factor analysis and an oral glucose tolerance test, if appropriate.

New Guidelines Omit the Best Test

The insulin tolerance test is the best screening test for type 2 diabetes. It measures insulin levels after drinking a sweetened drink.

The information is invaluable. Ask your doctor about the test if you're concerned about diabetes.

On a positive note, the ADA finally recognizes the importance of diabetes self-management and education.

These areas are proven to improve adherence to standard of care, to educate patients regarding appropriate glycemic targets, and to increase the percentage of patients achieving target A1c levels.

Successful strategies to improve diabetes care, which have resulted in improved process measures such as measurement of A1c levels, lipid levels, and blood pressure, include the following:

  • Delivery of diabetes self-management education.
  • Adoption of nutritional guidelines and having them readily accessible.
  • Use of checklists mirroring guidelines, which help improve adherence to standards of care.
  • Practice changes, which may include access to A1c testing.
  • Assigning a case manager to each patient.

What You Need to Do
  1. Take an insulin tolerance test (in addition to standard blood tests).
  2. Find a case manager.
  3. Optimize control by adhering to key diabetic diet guidelines.
  4. Create a diet based upon the diabetic food pyramid.

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