A1c diabetes test good predictor of cardiovascular disease

July 16, 2010

in Health News

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By Aaron Melius
Health Technology Network

Diabetes has fast become one of the most widely diagnosed conditions in the US.  As of 2007, the American Diabetes Association through the National Diabetes Fact Sheet reported the 23.6 million children and adults in the US have diabetes.  That’s a stunning 7.8% of the total population.  1.6 million new cases are diagnosed each year.  They further estimate that over 57 million people have pre-diabetes conditions.  Pre-diabetes tests can help determine if your diabetic but what about your risk of cardiovascular disease?  New study results published in the New England Journal of Medicine  may bring some new hope.

The complications from unmanaged diabetes can range from simple things like lack of energy or problems getting a good nights rest to very serious repercussions such as blindness, kidney disease, cardiovascular disease and heart attack.  Doctors have used a simple fasting glucose plasma test (FPG) for years to determine a persons ability to process sugar.

Here’s how it usually works:

  1. Fast for more than 12 hours (usually overnight)
  2. Drink a concentrated sugary solution
  3. Test you blood glucose levels after a period of time

The results are a reflection of the only current state of glucose in the blood.  If your glucose levels do not return to a normal range within an period of time (generally a few hours) you are generally considered to have impaired glucose tolerance (IGT).  Levels between 140-200 mg/dl are considered pre-diabetic.

The American Diabetes Association Risk Test for Diabetes can help you determine if you are at increased risk for diabetes or pre-diabetes. A high score may indicate that you have pre-diabetes or at risk for pre-diabetes. Take the test and find out for sure.

Glycated hemoglobin or A1c is that portion or percent of total hemoglobin that has glucose attached to it.

In people without diabetes, about 4% to 6% of their hemoglobin is glycosylated. Red blood cells that contain the hemoglobin circulate in the bloodstream for 3 or 4 months before being broken down and replaced. During that time the RBC can bond, irreversibly, to glucose in the bloodstream. Thus, A1C readings higher than about 6% indicate higher than normal amounts of glucose roaming the bloodstream in the past 120 days.

Glycation of hemoglobin has been associated with cardiovascular disease, nephropathy, and retinopathy in diabetes mellitus.

In the study glycated hemoglobin (A1c) was compared to fasting glucose for effective screening for diabetes and cardiovascular disease, stroke and coronary heart disease simultaneously.  The study found that in some conditions, this newer test showed a significant improvement in predicting diabetes realated complication risk.

“The hazard ratios for stroke were similar…The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant in models with adjustment for all covariates as well as glycated hemoglobin. For coronary heart disease, measures of risk discrimination showed significant improvement when glycated hemoglobin was added to models including fasting glucose.”

The study concluded that glycated hemoglobin (A1c) was equally as good at screening for diabetes but was “more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose.”  They added that their finding supported the use of this test as a good diagnostic test for diabetes.

Sources

http://www.diabetes.org/diabetes-basics/diabetes-statistics/
http://www.diabetes.org/diabetes-basics/prevention/diabetes-risk-test/
http://content.nejm.org/cgi/content/short/362/9/800?rss=1&ssource=collectionSearchRss&queryTerm=13
http://en.wikipedia.org/wiki/Glycated_hemoglobin
http://diabetescenter.blogspot.com/2007/07/change-may-be-in-works-for-hba1c.html

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