Is Your Doctor Wrong About Your Diabetes Diagnosis?

Modern medicine today is based on diagnosing a disease. But how to diagnose a disease is not always agreed upon.

Take diabetes, for instance. Recently, doctors have increasingly relied on A1c blood testing to diagnose diabetes. Now, a new study suggests that A1c levels can miss the diagnosis in certain people.

“Based on our findings, A1c should not be solely used to determine the prevalence of diabetes,” said lead researcher Maria Mercedes Chang Villacreses, M.D. Dr. Chang is an associate of City of Hope’s Diabetes and Metabolism Research Institute in Duarte, Calif. “It should be used in conjunction with a glucose tolerance test for increased accuracy.”

For those of you who don’t know about this, the A1c is a test that shows the average level of blood sugar over the past three months. People who have diabetes usually have this test to see whether their blood sugar levels have been staying within a target range. Doctors like to use it because it’s easy and inexpensive, and you don’t have to fast or prepare.

A glucose tolerance test measures the body's response to sugar intake. In this test, the doctor takes your blood sugar in the morning after an overnight fast. Then, you drink a special sugar drink, and the doctor measures your blood sugar again two hours later. The glucose tolerance test has been the gold-standard test for diagnosing diabetes for over 80 years.

In their study, the researchers looked at 9,000 men and women without a diabetes diagnosis. Then, they gave each of them both an A1c test and a glucose tolerance test. When they compared the results, the researchers discovered that the A1c test was not all that effective at diagnosing diabetes. The A1c missed 73% of diabetes cases detected by the glucose tolerance test. According to Dr. Villacreses, “The A1c test said these people had normal glucose levels when they didn’t.”

The researchers also confirmed that race and ethnicity had a significant impact on the accuracy of the A1c test. Because of differences in hemoglobin and the shorter lifespan of their red blood cells, normal A1c levels tend to be higher in many Black and Hispanic people.

Now, here’s why I think this whole project of how to best diagnose diabetes is relatively unimportant.

It’s because our current medical system is operating after the fact. Close to 100% of adult-onset diabetes is completely preventable. Instead of being so curious about the best way to diagnose it after the fact, why not focus on preventing it from happening in the first place? Prevention is easy and cheap. Getting sick is difficult and expensive. Here’s the best plan.

Get your A1c level checked every two to three years. If you have a black or Hispanic background, and especially if there has been some adult-onset diabetes in your family, your A1c level should be below 6.1%. If you have a white background, your A1c should be below 5.7%. If your levels are higher than this, then you might have diabetes in your future unless you change some things. In that case, read my book, The Type-2 Diabetes Breakthrough, to learn how to prevent it.

Yours for better health,

Frank Shallenberger, MD