This post is really for my non-diabetic readers. If you are diabetic you are all too familiar with your HbA1c, or A1C as we commonly abbreviate it.
<DISCLAIMER>I am not a doctor and you would be a fool to make medical decisions based upon anything you read online including in this blog.
When people find out I’m diabetic they typically have lots of questions about the disease. One of the questions/comments I get a lot goes something like this “my doctor says I’m pre-diabetic but I don’t know what that means or what I’m supposed to do with that information.”
Odds are they are hearing this from their primary-care physician (PCP) who is looking at a fasting glucose result which is where the problem starts. The problem is twofold. Part one is that – with all due respect to generalists, internists, and family-practitioners – they typically don’t know much about diabetes besides what they were taught in med-school. I don’t mean to sound harsh but the misinformation I’ve heard from my own PCP and what I hear other people’s PCPs tell them is frightening. In my experience their information is either out of date or too generalized to give them an informed understanding about diagnosis and treatment. So step one if you’ve been told you are pre-diabetic: get yourself to a specialist, aka an endocrinologist.
Step two: demand an HbA1c blood test and ask for the specific result, not just the doctor’s interpretation. The fasting glucose test, in my opinion, is fine for detecting the possibility of diabetes but is useless for diagnosis and treatment. The fasting glucose test measures your stable blood glucose (bg) at one point in time, typically first thing in the morning. The problem is that for some people this can be perfectly normal even though they are experiencing dangerously high spikes in glucose after meals and, as it turns out, it is the spikes that do most of the damage. The HbA1c test uses a clever trick to assess a 3-month average of your glycemic profile from a single blood sample and it is, in my opinion, the gold standard by which diabetes should be diagnosed and monitored.
But don’t just take my word for it, take a look at this study, or if you prefer, the less technical summary. Here’s the punchline:
Glycated hemoglobin (HbA1c) outperformed blood glucose as a predictor of cardiovascular disease (CVD) and all-cause mortality and had similar predictive accuracy for diabetes, data from a large cohort study showed.
Ok, so you’ve got your HbA1c. What does it mean and what exactly is pre-diabetes? Officially, an A1C below 5.7% is considered normal, 5.7-6.4% is prediabetes, and 6.5% and above is diabetes. So if you are in the high-fives (ha, down low, too slow!) or low sixes does that mean you are fine and have nothing to worry about? Sadly not.
The fact of the matter is that any A1C above normal (5.7) increases your risk of diabetes related complications. Take a gander at this chart from the aforementioned study (fear not the statistics and technical terms – I’ll explain it all shortly):
These four charts describe the risk of various hazards associated with levels of glycated hemoglobin – the thing that is measured by the HbA1c test. Charts B through D are the really interesting ones that show, respectively, the risk of coronary heart disease, stroke, and death. In each case the increase in risk starts pretty early – in the mid 5’s – and climbs appreciably well before reaching 6.0.
This excellent article on diabetes and eye disease has this to say about HbA1c:
So what does this all mean? It means that pre-diabetes is simply the short range where the risk curve starts to climb. It does not mean that being pre-diabetic is nothing to worry about and can be safely ignored.
Know your HbA1c.
See an endocrinologist.
Let’s be safe out there.