The Debate over A1C versus Average Glucose
Reprinted with permission of Amy Tenderich of diabetesmine.com.
Remember that little discussion about abandoning the established A1c for a new Average Glucose (AG) measurement? Well, guess what? This is pretty much the "dumbest idea ever floated" in diabetes, according to my favorite irreverent industry expert, David Kliff of Diabetic Investor.
Indeed, the ADA and a number of other powerful health organizations -- the International Federation of Clinical Chemistry (IFCC), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) -- now have an agreement in place to evaluate the accuracy of the A1c and potentially switch to the new AG units, contingent on results of an international study currently underway. The new standard apparently won't change the chemistry of the test itself, but only the "reference method," i.e. how the machines that conduct the tests are calibrated, and how the results are reported.
So why is this idea so dumb? According to Kliff, it's "purely academic" and will have no value for patients in the real world, other than to confuse the heck out of them.
The notion sounds good: average blood glucose results should be reported in the same unit measurements patients use for self-monitoring, so that everybody is "using the same language to communicate glucose goals."
BUT, Kliff points out, the A1c as it stands is the ONLY number most patients understand. He cites the great masses of non-insulin-dependent diabetics who don't use their home glucose monitors at all, because they don't know what the results really mean or what they should do with those numbers.
With the A1c, on the other hand, it's easy to understand that any number under 7 is good and any number above 7 requires action. So how in the heck will patient education be improved by replacing an easy-to-grasp test result with a new number that most patients don't understand?
Hmm, you'll note that the current AG study is underwritten by the likes of Abbott Diabetes Care, Bayer HealthCare, GlaxoSmithKline, LifeScan, Inc, Medtronic MiniMed, and Merck & Co. -- so I'm guessing these companies must have something to gain here.
And that's not all. According to Kliff, the great race to introduce non-invasive glucose monitoring provides even more evidence of "just how far out of touch people from academia can be with reality."
"For years, Diabetic Investor has been saying the so-called pain factor is vastly over-rated when it comes to why patients don't test regularly. The simple fact is that the majority of patients don't understand what the results mean and there see no action step based on the results. Why would anyone do something that does not add value to their lives or improve their outcomes?"
Touché. But I'm not sure I agree with you on the pain factor there, David. Admittedly, I'm a Type 1 currently bleeding at least a dozen times a day to get a number that I do understand (the result, if not always the cause) and can act on. I sure do agree, however, that the current A1c is generally less confusing than daily readings. So if it ain't broke, don't fix it. Correct?