A hemoglobin A1c test is widely considered a standardized test for diagnosing diabetes. A1c levels are measured in this test and a level of 5.7% higher than average showcases a high blood glucose level. The average baseline in this test is 117 mg/dl, and the A1c diagnostic area of 5.7 to 6.4 is considered prediabetes. Anything higher than this range often results in a diabetes diagnosis.
In a new study published in ENDO, scientists have discovered that the A1c test is lacking in evidence for accurately diagnosing diabetes. The A1c test misclassified the diagnosis of diabetes in more than 70% of cases. A study was recently conducted by researchers at the City of Hope National Medical Center located in California and The University of Kansas Medical Center in which the diagnostic specificity and sensitivity of the A1c and oral glucose tolerance test (OGTT) were compared. The A1c test is a test of averages in blood glucose levels over several months for participants. On the other hand, OGTT is a test that delivers real-time blood glucose response after a glucose challenge in testing. This test can provide a far more direct measure of a person’s glucose tolerance.
The researchers examined data collected from the year 2005 up to 2014 from samples of over 9000 case logs. Pre-existing diabetes diagnosis files were not considered in this study. The participants had their BMI, fasting plasma glucose levels, post glucose blood sugar levels, and A1c levels all cross-examined. The researchers identified that 73% of the diabetes cases that they tested were not picked up by an initial A1c test. The OGTT test was far more accurate in producing an accurate diabetes diagnosis.
The A1c test showed that the participants were experiencing normal glucose levels even when they were not. The A1c is particularly useful in identifying patients that have prediabetes or an increased risk factor, but it may not be the best basis for diagnosis. While it can be particularly valuable for managing diabetic complications or preventing diabetes through early diagnosis, the best way to monitor diabetes accurately is through the oral glucose tests.
According to current statistics by the American Diabetes Association, 20% of the US population that has diabetes currently remains undiagnosed. As the prevalence of diabetes continues to increase, there needs to be an ongoing awareness to improve the standard of protocols and to deliver a more accurate diagnosis for those that need assistance in managing the condition.
According to the International Diabetes Federation (IDF), there are approximately 425 million individuals living with diabetes. By 2045, the population with diabetes is expected to increase to 629 million. According to the World Health Organization (WHO), one in three adults globally is suffering from diabetes. Diabetes is expected to increase because roughly 352 million people are predisposed to have diabetes. The values indicate that 6 percent of the population has diabetes, and 5 percent are predisposed.
Due to these alarming numbers, many organizations have formed to set parameters that will, in turn, reduce the risk for an individual to develop diabetes or will train them on how to better manage the condition. If diabetes goes untreated, it can increase the risk of stroke, heart attack, kidney failure, and death.
Figure 1: IDF Diabetes Population in 2017 and 2045
Organizations Trying to Stop the Diabetes Epidemic
In the previous decades, the prevalence of diabetes globally has increased and will continue to rise if the preventative measures set by governments and health organizations fail. Listed below are global organizations that are combating the spread of diabetes:
Center for Disease Control (CCDC)
Center of Disease Prevention (CCDP)
International Diabetes Federation (IDF)
World Health Organization (WHO)
Figure 2: Healthcare Expenditures to Treat Diabetes in 2017
These are only a few examples of the many organizations that are investing time and money on research that will help prevent and manage diabetes. The current amount that was globally spent on healthcare expenditures to treat diabetes in 2017 was $727 billion. The United States alone accounts for $348 billion of spending to treat diabetes because a large amount of its population has diabetes or is at high risk to develop the disease.
Global Measures on Diabetes
As mentioned previously, there are many organizations that strive to find solutions for those affected by diabetes. At the same time, some organizations have collaborated to further improve their analysis and preventative parameters in economically impoverished and wealthy cities. These programs are being implemented all over the world in nations where diabetes is an ongoing epidemic.
The Center for Disease Control and the Center of Disease Prevention established a monitoring system to survey the upward trend of diabetes in rural cities globally. The organizations determined that healthcare expenses caused by diabetic-related diseases have led to poverty. The following list describes the current standard methods used to prevent diabetes:
Organize educational sessions to train and inform rural and village health care providers on diabetes prevention and management.
Provide technical support and assessment for patients’ self-management.
Evaluate high-risk diabetic elements and provide a screening service to individuals.
Train people with diabetes standard self-management skills.
The organization’s goals are to educate impoverished communities on how to better manage their diabetes. However, training people on self-management alone is not the best way to prevent diabetes. The diabetes epidemic is so alarming that even governments within cities have set up their own preventative measures.
To prevent diabetes from further affecting their citizens, action plans have been set to facilitate a health-enhancing physical and social environment to promote health advice to manage diabetes. Government’s all over the world have made it their goal to gather as much data in hopes of implementing the appropriate strategies to combat diabetes. This global research has led to three targeted goals that are being focused on for improved results:
Reduce the risk of individual’s becoming pre-disposed to diabetes.
Stop the exponential growth of diabetes.
Improve the availability of inexpensive medical devices and medicines to treat diabetes.
Multiple governments and health organizations put an emphasis on improving technology and medicine for halting diabetes because they determined that educating the population on self-management alone was not going to fix the problem. The global objective is to implement more accurate medical devices that monitor diabetes. In the 1970’s, diabetes monitoring was invented to help those with diabetes control their sugar intake at home. The two most popular methods used today are daily testing through self-monitoring of blood glucose (SMBG) and long-term testing through glycated hemoglobin (HbA1c). However, these methods still contain some faults and there is a need for faster and more accurate results to match with the growing numbers. Many nations will need to develop a more efficient and faster point-of-care diagnostic device in order to stop the growing diabetes epidemic.
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