A1C for diagnosis of diabetes

I wonder what caused the change of opinion. Not long ago (2007), ADA said, "The use of the hemoglobin A1c (A1C) for the diagnosis of diabetes is not recommended at this time" and in 2006, American Family Physician said, "because A1C testing is not sensitive enough to rule out diabetes if levels are normal, the test should not be used for diagnosing diabetes."

I think they had several concerns. First, A1c does not reflect blood glucose levels in some people. Second, the A1c costs a lot more than simple BG tests and would be expensive if everyone were tested annually.

However, I'd certainly be in favor of an A1c for anyone at risk.

I am against using the HBa1c as a diagnostic tool. The reason is that it takes time for a person to get above teh 6.5 criteria for diagnosis. It costs money to do any test and the fasting and OGTT are much more reliable tests. I feel that too many people who have diabetes will be missed if the HBa1c becomes a diagnostic tool and will not be diagnosed in a timely manner. I can see it being used to figure out how long the person has been developing or has  had diabetes but not as a diagnostic tool in and of itself