Sugar Matters
February 8, 2011
So you think you are safe, eh? Pre-diabetes revisited…

About two weeks ago I received my copy of the American Diabetes Association’s clinical recommendations. These come out very year in January and are the benchmarks for diabetes care. They generally reflect the opinions of experts from both the American organization, and also its European counterparts as well.{{more}} Given our ongoing discussions about pre-diabetes, when I came upon a section dealing with future risks for pre-diabetics I thought certainly I had to share this with my Vincy family!

The interesting thing to me at the get-go is that we now have a range of A1cs whereby we can categorize pre-diabetes. It is no longer based only on the value of fasting or glucose-challenge blood sugar. Note that the levels I will be discussing do not apply to someone with KNOWN diabetes who then has an A1C of these values while on treatment. This is for screening (first testing) purposes only. So if you have no history of diabetes ever before, and walk into the lab to get your blood checked and they say:

“Your A1C is over 6.5%” – you have diabetes based on this level. According to the new guidelines A1C levels above 6.5% are considered diabetes range. The test should be repeated or another test be used to back it up, UNLESS you have other symptoms of high blood sugars, or the value is clearly high. An A1C right at 6.5% can be in question, but one of 7.5% is not in question – you certainly have diabetes then.

“Your A1C is 5.9%”-you would be categorized as having pre-diabetes now, based on the new criteria. Whereas five years ago, an A1C of less than 7% would have told the doc that you did not have diabetes and that was about it. Now, we actually use the A1C for stratifying risk of diabetes and levels of glucose abnormalities; it is not black and white, yes or no anymore. In the new criteria, an A1C between 5.7% – 6.5% is pre-diabetes.

“Your A1C is 5.6%, normal.”— and you think, ah, I am safe, no diabetes, no pre-diabetes even. NOT SO!!! Research is finding that abnormalities in glucose levels, even when mild and not in disease range yet, can still carry high risks for the future. Someone with an A1C between 5.5-6%, therefore including some people not even categorized as having PRE-diabetes, STILL HAS A HIGHER RISK of developing diabetes in the next 5 years-in fact it is between 5-25% increased risk, depending on which research you read.

Those with A1C ranges of 6-6.5%, that is pre-diabetes range, have a 25-50% change of developing diabetes within 5 years.

So why am I throwing all these numbers at you this week? I want to continue to remind you of two things:

1)getting screened is important. PLEASE speak to your doctor about checking for diabetes AND PRE-DIABETES so that you can address the risks with appropriate life changes and treatment as soon as possible.

2) pre-diabetes carries a high risk for developing diabetes n the near future. People just don’t often sit at pre-diabetes range-they tend to progress and worsen. And now, this new information is showing us that previously “normal” A1Cs are in fact NOT NORMAL at all.

So get on it Vincy family! Until next week, stay safe and healthy!

Anita Ramsetty, MD

Staff Endocrinologist

Roper St. Francis Hospital