The Value of Screening:
HbA1c as a Diagnostic Tool
David Kendall, MD
Chief Scientific and Medical Officer
American Diabetes Association
www.diabetes.org
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Diabetes is Serious and Increasingly
Common in the U.S.
• 23.6 million Americans have diabetes
• An increase of nearly 3 million between 2005
and 2007
www.diabetes.org
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• 1 out of 4 Americans with diabetes are
undiagnosed (nearly 6 million people)
• 57 million Americans have pre-diabetes:
elevated blood glucose levels that place
them at much higher risk of developing
diabetes
www.diabetes.org
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•
Every 20 seconds somebody in the
U.S. is diagnosed with diabetes
•
Every day 4,320 people in the U.S. are
diagnosed with diabetes
•
Over 1.5 million people will be
diagnosed with diabetes this year
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Who Should Be Screened for Diabetes?
1. All adults who are overweight and have additional risk factors:
•
•
•
•
•
•
Physical inactivity
First degree relative with diabetes
Members of a high risk population groups
Women diagnosed with gestational diabetes or who delivered a baby weighing >9 lb.
Hypertension (high blood pressure) or cholesterol abnormality
Other clinical conditions associated with resistance to the effects of insulin
2. In the absence of the above criteria, testing should begin at age 45
years
3. If results are normal, testing should be repeated at least at 3 year
intervals, with consideration of more frequent testing depending on
initial results and risk status.
These criteria consistent with those used in scientific studies of
diabetes prevention
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US Preventive Services Task Force
• Currently recommends diabetes screening for
asymptomatic adults only in the case of sustained
high blood pressure: greater than 135/80 mm Hg
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Screening for Diabetes
• FPG  126 mg/dl
•
No food or drink for at least 8 hours
• 2 hour glucose  200 mg/dl during an glucose tolerance test
• A1C  6.5%
•
Using an accepted and standardized laboratory test
• If classic symptoms of high glucose = any glucose  200 mg/dl
NORMAL
PREDIABETES
DIABETES
FPG < 100
FPG > 100 – 125 (IFG)
FPG > 126
2-h PG < 140
2-h PG 140 – 199 (IGT)
2-h PG > 200
A1c < 5.7%
A1c 5.7 – 6.4%
A1c > 6.5%
American Diabetes Association. Diabetes Care 33( Suppl 1), 2009
www.diabetes.org
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A1C: The Results
• Normal: A1C of less than 5.7 percent
• Pre-Diabetes: A1C of 5.7 percent to 6.4 percent
• Diabetes: A1C of 6.5 percent or higher
www.diabetes.org
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Screening for Diabetes with the HbA1c Test
• Measures the amount of glycated hemoglobin in the
blood.
• Traditionally used to track blood glucose control over
time.
• Now recommended as an effective diagnostic tool.
www.diabetes.org
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Factors Supporting Use of A1C for Screening and
Diagnosis
• A1c testing does not require overnight fast
– Increase rate of screening during non-fasting hours
• HbA1c reflects long-term glycemic burden
– Relatively less affected by acute (e.g., stress or illness
related) perturbations in glucose levels
• Accepted and current guide in management of
diabetes
– A1c laboratory methods well standardized and reliable
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Diabetes Can Cause Dangerous
Complications
Every Day:
• 230 people with diabetes undergo an amputation
• 120 people with diabetes enter end-stage kidney
disease programs
• 55 people with diabetes go blind
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• One in three children will develop diabetes in his or
her lifetime
• For minorities, nearly one in two will develop diabetes
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Questions?
Contact:
Meghan Riley
Manager, Federal Government Affairs
American Diabetes Association
mriley@diabetes.org
www.diabetes.org
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