niccolo wrote:
chunderfuzz wrote:
My guess would be because diabetes is defined as a blood glucose disorder, not a protein glycation disorder.
That requires some parsing...but I think what you're trying to say is that since the way an A1c measures average blood sugar is by measuring the bonding of glucose to hemoglobin, i.e. the glycation of the protein that is hemoglobin, therefore A1c somehow doesn't shed light on blood glucose. If my interpretation of your comment is correct, then you seem to be confused, because 1) it's precisely that protein glycation that allows us to infer average blood glucose levels and 2) A1c *is* one of the accepted diagnostic measures for diabetes, notwithstanding our physician colleague missing the memo on that. Or am I misunderstanding your comment? I didn't say it doesn't shed light on blood glucose, just that it's not the defining factor of diabetes, it's secondary to a glucose disorder and there are other factors which can cause it to be elevated.
1) It does, but that's also a problem, if I stick my feet in the freezer and head in the oven, on average, my external body temperature is pretty good. Extremes for whatever reason will be recorded in the A1c, this doesn't necessarily make someone a diabetic, may just indicate they were sick/injured in the past.
2) While it is accepted it does have a number of cons and pros which the ADA outline, lab standardisation being one, standardisation with blood glucose is much better, low B12 and other conditions can cause the result to be off/wrong...in a patient with a prediabetes result like the OP here, relying on one test only to label them as 'pre diabetic' when they are a lean/fit patient wouldn't be the best outcome. Medicine isn't always about using blood results to diagnose, you need to look at the patient as well, a lean fit person with a one off elevated A1c should indicate further testing rather than saying they are prediabetic and you need to eat better etc. (I'm not saying a lean fit person can't be type 2 diabetic or type 1, just that out of nowhere, a prediabetic reading in a lean person seems odd and needs a closer look).