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The value of the HbA1c test

Discussion in 'US Health Care Reform' started by TheFormerLantusFiend, Jul 28, 2010.

  1. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

    Sep 10, 2006
    I recently read a book by a doctor about our medical system and he claims in passing that regularly checking A1c improves diabetes outcomes.
    Does anybody know if that's at all true? Does having one's A1c checked actually correlate with a better outcome in any way, regardless of what that A1c is? If people are randomized to a group that gets it checked annually or a group that gets it checked quarterly, will the group that gets it checked annually have higher A1cs or be more likely to, while they're at the hospital, get something useful?
  2. Amy C.

    Amy C. Approved members

    Oct 22, 2005
    Based on my own personal experience. I start to pay attention about a month prior to a visit to be sure my son is doing what he should be doing. This lasts for about another month or so. He goes every 4 months, so half of those months the control is better than the other half.

    So yes, it helps to have the A1c done more often than once a year or every six months.
  3. jilmarie

    jilmarie Approved members

    Jan 29, 2007
    Just speculating, but I would assume that people who get their A1C checked regularly also regularly visit with their diabetes team and might take a more active role in their disease management.
  4. Lisa P.

    Lisa P. Approved members

    May 19, 2008
    Afraid I tend to get twisted with logic puzzles, but I don't see how checking A1C regularly could, in itself, improve outcomes. Checking A1C only gives you information, outcomes can only improve because of what you do, not what you know.

    So, of course, this was probably shorthand for "checking A1C gives you better information and therefore improves the quality of your actions which therefore improves your outcomes". Or it might be "checking A1C regularly is is an indicator that you are the kind of person who gathers information and takes action and therefore there are better health outcomes for a population that checks A1C than for one that doesn't".

    My first thought would be that for any one individual this may not be so. Some people can check twenty times a year and not have the ability or desire to make improvements based on that info. Others may make the wrong changes. For example, for Selah's age we have a good A1C. That might tend to make me rest on my laurels, and be less careful than I would have otherwise. But her bg many days, as per the dexcom, is straight up and straight down all day long. That A1C average is not reflecting that she really does have high bg very frequently, which does damage. Also, if I did not have the dexcom and she had a good A1C, I might think she was maintaining healthy bg levels all the time if she were actually going hypo and hyper all the time, ramp up what we were already doing, and wind up doing a lot of harm.

    I do know people, type 1 and 2, that dodge the A1C test. They do it specifically because they think they are doing fine and don't want to know differently. One is a type 2 that thinks 250 is a fine number to see because he has friends that rest at 300. Another is a type 1 adult who insists she rarely goes over 170, her target top, almost never. I think she tests three or four times a day, before meals. Somewhere inside I think she knows she doesn't want to see that she's going higher than she'd like between meals.

    So I would guess that for many, NOT getting an A1C is an indicator of some other decisions that effect health outcomes. But I would argue that the correlation is indirect, that the statement you read is likely speculative ('that's just common sense" sort of thinking),and that no matter what it applies to populations and not individuals.

    I have found that understanding the difference between something that is true for a population and something that is true for an individual is kind of a blind spot for a lot of medical folks. I've run into many situations where a doctor or nurse is given a directive or a "rule" based on research about populations, and can't understand that it might not apply to the specific case in front of her.

    None of which answers your question, so this is kind of just a very, very long bump. . . .:(
  5. CAGrandma

    CAGrandma Approved members

    Mar 14, 2006
    I'm not sure how they did the study - if it would be considered a valid, reliable study - but the key point to me is that testing HbA1c was found to be CORRELATED to better results - not to cause them. One of the simplest explanations might be that people who do not have health insurance do not get HbA1c tests, nor do they go to the doctor to get the results interpreted and those with health insurance to pay for the test do.
    So it is interesting but doesn't actually suggest that the test itself does anything to foster better results.
  6. chbarnes

    chbarnes Approved members

    Jul 5, 2008
    The implication is that feedback modifies behavior and improves control. Amazingly, there is some evidence that CGM improves control in Type 2.


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