October 16, 2014

Frequency Important in HbA1c Testing

I must state that after reading this short piece in Diabetes in Control, I started this blog and then I tried to follow the link at the bottom. This led to more confusion and much doubt. It turns out that the link was not to the correct article in Diabetes Care, but to a Pub Med article titled “The relationship between alcohol consumption and vascular complications and mortality in individuals with type 2 diabetes.” I had expected the article to be behind a pay wall, but not this.

The short article made no mention of where the study happened, but the article alluded to the ADA. False, the study was done in the United Kingdom and in my reading of the full study, kindly provided to me by David Mendosa, I have more questions than answers, to the point of actually thinking junk research.

Some of the points that raise questions include:
#1. Data collected after the fact from laboratory reports.
#2. Data not from a randomized-controlled trail, although this is made as a suggestion by the researchers. Of course, they want more funds for this type of a trial.
#3. Dosage adjustments and other interventions are not documented.
#4. Data for too short a time frame.
#5. Data too general and not specific – example for those receiving quarterly A1c tests and had initial A1c greater than 7% had an A1c reduction of 3.8 percent. If the average were 8%, this would be greater than 7.1%.

I would agree with the research just in the fact that among our support group members, those that test quarterly have a lower overall A1c average than the two individuals that are tested on a six-month schedule.

Then there are those that use the home A1c test on a monthly basis, two members, and they have in general the best A1c levels. One is on insulin and one is on no medications. For more information on home testing read this blog by David Mendosa.

The practice pearls offered by the Diabetes in Control author are reasonable and I will quote them.
  1. While clinical guidelines are in place for HbA1c monitoring frequency, the recommended intervals are often not followed appropriately in practice.
  2. This study showed that following the recommended testing interval recommendation was associated with a lowered HbA1c, particularly in those patients with HbA1c's of >7%.
  3. Patients with testing intervals of 6 months or more were associated with increases in their HbA1c values.

The testing of A1c should not replace the testing done by individuals, but as a way of informing patients that their testing is either showing them that they are doing it right, or that they are not testing often enough or at the right time.

The recommendations by the ADA and AACE of relying only on the A1c by patients should never be followed, as this leaves the patient managing his or her diabetes in the dark and makes it more difficult to understand what is being done right or wrong.

If you have made it this far, you should read David's blog from yesterday.  He is able to put a positive light on the study.  I was upset by the false link provided by a fairly reputable service and let my negative side take over.  For this I make no apologies, as we need to be aware of weaknesses in studies and when studies are not telling us the whole story.

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