DFIB Posted July 20, 2012 Posted July 20, 2012 I am trying to understand the relationship of a "high risk of diabetes" A1c and Blood Glucose Level as it concerns the primary diagnosis of diabetes. The scenario is a 72 y/o slightly overweight female that receives a consult at an urgent care clinic. Her chief complaint is "just haven't been feeling very good". Patient request blood testing. Physical examination is negative. Her BGL is 105 mg/dl and her A1c is 6.2 %. My questions are these: 1. Is the A1c only relevant in the diagnosis of diabetes because her BGL is over the threshold of 100 mg/dl? 2. If she lowered her blood glucose through diet and exercise would the A1c become less relevant or is an A1c of 6.2% have a free standing relevance? 3. Should the patient modify diet and exercise and have the test performed again after she seeks a consult with an internist? 2
Kaisu Posted July 20, 2012 Posted July 20, 2012 A blood glucose of 105 and an A1C of 6.2 is not diabetes. This indicates blood sugar levels within normal limits. Remember that the A1C reflects average blood sugar levels over 3 months, the life span of a red blood cell. 1
paramedicmike Posted July 20, 2012 Posted July 20, 2012 A hemoglobin A1C test provides an idea as to how well the patient's diabetes has been controlled over the last three months. A HgbA1C is independent of BGL when looking at a one time glucose level. When trending values, however, it will become more important. If she lowered her BGL through diet and exercise, or even meds, it would still be a relevant lab value over time to determine how well the diabetes is controlled. Normal Hgb A1C for a non-diabetic patient is 4%-5.6%. A reading like what you referenced in the OP would not even necessarily indicate diabetes. Levels greater than 6.5% generally indicate diabetes. Diet and exercise modification will depend on what the diet and exercise regimine look like now. Without knowing the current status its impossible to say if a modification is needed. A repeat test, if completed, will need to be done in three months time as the reading is an average of the prior three months. So testing next week or even next month won't really tell you anything.
DFIB Posted July 20, 2012 Author Posted July 20, 2012 Thanks guys, I was thinking along the same lines. The Dr. at the urgent care clinic told her she had diabetes and needed to start medications and I disagree but I am only and EMT, you know, so the weight of my clinical opinion amounts to just about nothing. I also wanted to make sure that I was not in the ditch with my thought process.. She can modify her diet significantly by reducing cookies, ice cream and fruit juices, and processed cereals and increase he total protein intake. I think there is room to improve her BGL without starting the meds. The good news is that she is now obligated to find an geriatric internist that can follow her care in later life. I will post a follow up when new information is available. Thank you Kaisu and Mike.
rock_shoes Posted July 20, 2012 Posted July 20, 2012 A hgbA1C of 6.2% would indicate that a patient should undergo further screening for diabetes. A hgbA1C of 6.2% roughly correlates to having had an average BGL of 143 mg/dL (7.9 mmol/L for the non US types). My own treatment plan would start with 3 months of diet and exercise modification followed by a repeat hgbA1C. 6.2% certainly isn't high enough I would want to run straight to pharmacotherapy. Start simple when you can and ramp up from there. 1
Just Plain Ruff Posted July 20, 2012 Posted July 20, 2012 She needs to get with a endocrinologist. my a1c was 7.2and they put me on metformin. Why take the word of a doc at an urgent care when that doc is not her normal doc is what is my question. She needs to follow up with either her family doc or a endocrinologist. Sent from my SPH-D710 using Tapatalk 2
Kaisu Posted July 20, 2012 Posted July 20, 2012 Rock shoes, thank you for educating me. You are absolutely correct. That A1C does correspond to an average BGL of 143, which is diabetes. Teach me to shoot my mouth off. In my defense, I live with a diabetic and we target an A1C of around 6%, reassuring ourselves that the diabetes is under control. DFIB, sorry to steer you wrong. Listen to the smarter people here and get thee to an endocrinologist,
DFIB Posted July 20, 2012 Author Posted July 20, 2012 I am listening and very interested in the correlation between the A1c and BGL. No harm done. All of you guys are great!
rock_shoes Posted July 22, 2012 Posted July 22, 2012 (edited) Wikipedia does a reasonable job of explaining the concept. Of course, as with anything Wiki, source verification is required. http://en.wikipedia.org/wiki/Glycated_hemoglobin For a more practical analysis of the relevance of hemoglobin A1C, from a reputable source, try this article. http://jama.jamanetwork.com/article.aspx?articleid=202649 Edited July 22, 2012 by rock_shoes
DFIB Posted July 22, 2012 Author Posted July 22, 2012 Wikipedia does a reasonable job of explaining the concept. Of course, as with anything Wiki, source verification is required. http://en.wikipedia....ated_hemoglobin For a more practical analysis of the relevance of hemoglobin A1C, from a reputable source, try this article. http://jama.jamanetw...rticleid=202649 Thanks buddy. Those will be very helpful.
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