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The Value of Screening:HbA1c as a Diagnostic Tool

David Kendall, MD

Chief Scientific and Medical Officer

American Diabetes Association

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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

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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

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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

7American Diabetes Association. Diabetes Care 33( Suppl 1), 2009

PREDIABETES

2-h PG > 2002-h PG 140 – 199 (IGT)

2-h PG < 140

FPG > 126

FPG > 100 – 125 (IFG)FPG < 100

DIABETESNORMAL

A1c > 6.5%A1c 5.7 – 6.4%A1c < 5.7%

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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

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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.

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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

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