Working Around A1C test Shortcomings

Practically since its introduction in 1977, many medical professionals have considered the A1C test the gold standard for determining a patient’s average blood sugar (glucose) level.

Depending upon the result of the A1C test, the patient could be diagnosed as pre-diabetic or diabetic.

A1C Challenges

In recent years, researchers and others have called into question the efficacy of A1C tests. Along the way, several issues have been cited.

Issue: The A1C test underestimates diabetes’ prevalence. That’s according to a study presented at the 2019 session of the Endocrine Society’s annual meeting. Researchers found that A1C cannot be relied upon as the sole determinant of diabetes. Their recommendation is to use it in conjunction with an oral glucose test for improved accuracy.

Issue: The A1C test doesn’t always identify pre-diabetes or diabetes. As the chart above indicates, an A1C level of 6.5% indicates diabetes. But a patient’s percentage may come in lower than that even though they do have diabetes “if you have evidence of the insulin resistance syndromes that include high triglycerides, low HDL — your typical metabolic syndrome,” according to Javier Morales, M.D., FACP, FACE. Morales is an Associate Professor of Medicine at the Hofstra Northwell School of Medicine at Hofstra University and Vice President at Advanced Internal Medicine Group.

Issue: The A1C test works best as part of a diagnostic plan. After reviewing the available literature and discussing the issue, an international committee of medical experts reached a consensus that the A1C should be included among diagnostic tools for diabetes. In the ensuing years, however, the test has grown in prominence. The general public may view it less as one tool among others and more the only tool that matters.

Issue: Multiple conditions can skew A1C test results, resulting in either an increase or decrease in the numbers that the test returns. Such conditions include:

  • Kidney failure
  • Liver disease
  • Anemia
  • Medicines such as opioids and some HIV medications
  • Blood loss
  • Blood transfusions

Taking these issues into account, the A1C can at least contribute to a physician’s understanding of a patient’s potential development of pre-diabetes or diabetes. Considering that diabetes is the leading cause of heart disease, stroke, kidney disease, blindness, and amputation, that’s no small achievement.

READ MORE: How one practice noted A1C’s issues and turned its focus to DEXA.

DEXA’s Place in the Diabetes Landscape

Diabetes is among the several significant health issues that can result from metabolic syndrome. Other health issues related to metabolic syndrome include heart disease and stroke.

Establishing a patient’s metabolic syndrome susceptibility, then, would seem an effective way to stave off prediabetes or diabetes. But if a number of factors can render the A1C test unreliable, what options are available to a wellness professional?

One strong choice is DEXA.

DEXA’s ability to measure a person’s body composition — especially visceral fat — makes it a great tool to help stave off metabolic syndrome. That’s because visceral fat is a key element in the development of metabolic syndrome, and there is no better medical device available to gauge visceral fat than a DEXA machine.

Increasingly, medical professionals are circling visceral fat’s biologically active, potentially harmful qualities as public enemy number one when it comes to a person’s developing metabolic syndrome — which can include diabetes.

DEXA: Health’s Way Forward

A DEXA-based approach also addresses the issues with A1C:

  • Its industry-best precision means the amount of a patient’s visceral fat — and, therefore, a potential increase in the risk of developing diabetes — is not underestimated.
  • While the whole patient must be treated, which can require multiple testing tools, the DEXA’s ability to gauge not only visceral fat but muscle mass and bone density makes it an important cornerstone of any wellness plan.
  • Conducted properly, DEXA results cannot be skewed in the way that conditions such as anemia can skew A1C results.

Modern medicine contains no single “magic bullet” to diagnose and treat any patient. However, the more that is learned about the devastating effects that metabolic syndrome can have on a person, the more important it is to turn promptly to the best tools available for identifying it.

DEXA represents just such a tool. To learn more about what a DEXA machine can mean for your patients, your practice, and you, contact us today.



Get in touch with us today and find out how we can transform your practice with little to no financial investment up-front.
Want to become a provider and get more cash-based clients to your business? Fill out the form below: