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Diabetes Experts Recommend A1c Testing for Diabetes Diagnosis
American Family Physician, 06/25/09

Mitchell D - An international committee of diabetes experts has recommended that the hemoglobin A1c assay, which now is routinely used to monitor the course of disease in patients with diabetes and signal the pending development of diabetic complications, should become the new "gold standard" for diagnosing diabetes.

Hemoglobin A1c values vary less than with fasting plasma glucose, or FPG, levels, and A1c measurement has technical advantages compared with glucose testing.
Whereas both the FPG test and the less commonly used oral glucose tolerance test, or OGTT, require patients to fast, the A1c test does not.
A1c testing measures a person's long-term (i.e., preceding two to three months) blood glucose exposure. It gives physicians a more comprehensive understanding of a patient's overall health than other commonly used tests. It also makes the A1c test a better predictor of a patient's risk for complications than single or episodic measures of glucose levels.
Using an A1c cut-point of 6.5 percent or higher to establish the diagnosis of diabetes was justifiable, although the diagnosis has be confirmed with a repeat A1c test unless the patient displays clinical symptoms and has glucose levels greater than 200 mg/dl.
People with an A1c level of at least 6 percent but less than 6.5 percent likely are at high risk for developing diabetes.
A1c testing has not become widely accepted as a diagnostic tool because of its lack of assay standardization. An updated examination of the laboratory measurements of glucose and A1c by the current International Expert Committee indicates that with advances in instrumentation and standardization, the accuracy and precision of A1c assays at least match those of glucose assays.

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