At a more basic level, what does that 6.5% mean? “If you look at a mean average for A1C, 6% is around 130 mg/dL and 7% is around 165 mg/dL, ” Spollett says. “If people are diagnosed between 6% and 6.5%, they’re going to be called ‘at risk.’ So I think there will be some confusion about what those numbers mean and how to interpret them.”
Better Screening Needed
For now, the questions are theoretical. Until it is widely adopted, so is the recommendation. (The American Diabetes Association has assembled a task force to review the report and may issue its own commentary by the end of the summer.) But the discussion the report has generated provides an opportunity to focus attention on the problem of diabetes in this country.
“Even though we’re improving, we’re still not at a point where we can say that most of our patients have achieved really good control,” Burke adds. “So, using the A1C more appropriately to guide clinical decision-making in terms of medication management, referral to educators or dietitians—a paper like this really brings that into very clear relief.”
The consensus among Burke, Spollett, and Urquhart seems to be that clinicians simply are not screening enough for diabetes. “It still isn’t as widely known as the other screenings for cancer and heart disease,” Spollett says. “Even if it’s not [with] the A1C, clinicians should be screening patients appropriately and really asking the questions that patients need to hear about their weight gain and their exercise and sedentary level.”
“An A1C is just a number,” as Urquhart says. “That number corresponds to other things that are going on in the body. We need to tackle those things, all the different entities of dyslipidemia and hypertension and glucose and obesity.”