- A study by Johns Hopkins Bloomberg
School of Medicine tested the efficiency of prediabetes screening using
hemoglobin A1C test and blood sugar test.
- Hemoglobin A1C test found to
predict the risk of diabetes associated complications better than blood sugar
- This study aids in consolidating
evidence about the efficiency of hemoglobin A1C test in pre-diabetes testing.
study by Johns Hopkins Bloomberg School of Public Health on a test that
determines pre-diabetes status based on Hemoglobin A1C level in the blood
found that it is the
best method of determining who will develop complications due to diabetes over
the course of their life.
Pre-diabetes is a
condition in which the individual is at an increased risk for diabetes
. However, the method
of determining the condition has not been uniformly accepted. A case in point
is that The American Diabetes Association recommends that hemoglobin A1C test
or glucose levels could be used for the detection of pre-diabetes, while the
WHO recommends the use of only glucose levels.
‘Detection of prediabetes is a wake-up call for diabetes prevention.’
as an important diagnosis as people at this stage can
alter their risk for diabetes by changing their lifestyle, lowering their
weight and increasing their exercise regimen. The use of a drug called metformin
may also be used to lower glucose levels in the blood at this stage.
Bethany Warren, the lead
author of the study and a PhD student in the Department of Epidemiology at the
Bloomberg School said "The goal is to figure out who is at the highest risk of
not only developing diabetes but of developing
its serious complications
including kidney disease, cardiovascular
disease and even death. Hemoglobin A1C appears to be the tool that is best able
to do that."
This test determines the
glucose levels over a period of 2-3 months and, unlike, fasting and post
prandial blood sugar test, this test does not require the patient to fast.
When the glucose level
in your blood is high, it binds to the hemoglobin molecules. The hemoglobin A1C
test is used to determine the extent of glucose bound to the hemoglobin
molecule. The RBC lives for 3 months, therefore, the hemoglobin A1C test gives
the blood glucose level for 2-3 months.
A1C Test Against Blood Glucose Test
- Normal = <5.7 %
- Pre-Diabetes = 5.7-6.4%
- Diabetes = >6.5%
In a blood glucose test,
the glucose level is tested after a period of 8 hours and after consuming a
sugary drink after 2 hours. The drawback in this test is that it detects the
level of glues in the blood during this particular time.
In hemoglobin A1C test,
the blood glucose level over a period of 2-3 months is detected. Blood glucose
test identifies more number of people with a high glucose level than hemoglobin
A1C, however, not everyone will develop complications associated with diabetes.
of Identifying Pre-diabetes
Dr. Elizabeth Selvin,
one of the senior authors of the study and a professor in the Bloomberg
School's Department of Epidemiology said "When someone is told they have
pre-diabetes, we hope it will cause them to make changes to their habits in
order to prevent the development of diabetes and its complications."
- Identifying or terming someone's
condition as pre-diabetes will be like a wakeup call to adopt a healthier
- A diet that is
rich in nutrients and low in carbohydrates and sugar may be
- Business travelers who eat food
indiscriminatingly will become more conscious about their diet.
- Exercise will be incorporated
into the daily schedule.
- Identifying the condition will aid
in availing benefits from health insurance companies for further testing
It is extremely
important to identify people who are at high risk for diabetes as there are a
lot of lifestyle changes that need to be incorporated. Therefore it is also
important to avoid over diagnosis. The researchers in the current study
identified people at a high risk for diabetes complications more accurately
than other tests.
Risk in Communities Study
adults were tested for blood glucose levels as well as hemoglobin A1C between
the years 1990-1992. They were followed for a period up to 22 years to
understand the likely predisposition for diabetes,
and kidney. 7,194 adults were tested between
1996-1998 for fasting blood glucose and post prandial glucose. These study
participants were followed up for a period of 16 years.
In people who were diagnosed with being
in the pre-diabetes stage using the hemoglobin A1C test they were found to be
- 50% more likely to develop kidney
- Two times more likely to develop
- 60% more likely to die
The associations were
not as strong for people diagnosed to be in the pre-diabetes stage using the
blood glucose test.
India is considered the Diabetes capital of the
world and the numbers are continuing to rise.
people at high risk for diabetes could help in limiting the alarming rise of
Previous studies have
shown that diabetes was considered a disease of the old about 30 years back,
however, changing lifestyles and dietary patterns have increased risk factors
Diabetes Federation stated that the number of diabetics in India in the year
2015 was 40.9 million and the projected number for 2025 is 84 million.
WHO Health Organization has stated that the maximum increase of diabetics will
occur in India.
The number of diabetics
and the complications they undergo is a reminder of testing for pre-diabetes
and the need to bring concrete changes to one's lifestyle to prevent diabetes.
- Diagnosing Diabetes and Learning About Pre-Diabetes - (http://www.diabetes.org/diabetes-basics/diagnosis/)
- Hemavathi Dasappa et al; Prevalence of Diabetes and Pre-diabetes and Assessments of Their Risk Factors In Urban Slums of Bangalore - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC4535103/)
- American Diabetes Association - (http://www.diabetes.org)