The American Association of Clinical Endocrinologists (AACE) and The American College of Endocrinology (ACE) have approved the use of the A1c test as an additional criteria for diagnosing type 2 diabetes.

What’s your A1c? If you have diabetes and you don’t know the answer, you should.

In a survey conducted by the American Association of Diabetes Educators, only 24% of people with diabetes knew their A1c levels. Everyone with diabetes is familiar with the standard, fasting blood-glucose test that is used to indicate your current blood sugar levels. But while the fasting test remains an important part of diabetes treatment, its weakness is that it is an indication of your sugar level only at the moment you take the test. A fasting blood sugar doesn’t tell you anything about your blood-sugar levels the rest of the time.

The A1c or hemoglobin A1c test tell us the AVERAGE blood sugar level over a 3-month period. There is much confusion about this important test, so a bit of explanation is in order. Your red blood cells contain a protein called hemoglobin A, whose job it is to carry oxygen in the blood. Sugar in the blood also attaches to this same protein and glycates this protein. The more sugar that is in your blood, means there is more sugar to stick to the hemoglobin A protein. Once the sugar sticks to the protein it stays that way. So this becomes an easy way to look back over your shoulder to see your average blood sugars for the past 3 months.

What’s your number?

Experts agree that a normal A1c for someone without diabetes is between 4%-6%; anything above that should be considered a sign of diabetes.

But exactly where you should be on that scale is debated and the recommendations for target A1c levels vary. For instance, the American Diabetes Association recently changed its recommended A1c from under 8% to 7% or below. Meanwhile, the American Association of Clinical Endocrinologists (AACE) recommends an even lower number of less than 6.5%.

-dr.hinkes

In the May 23, 2009 issue of The Lancet Journal, Kushwin Rajamani and co-workers report a further analysis of the FIELD trial of fenofibrate in patients with type 2 diabetes, which shows a large effect of treatment on the rate of minor amputations during the 5-year study. The anti-cholesterol drug fenofibrate appears to reduce risk of amputation for patients with diabetes by as much as 36 percent, the study has found.

A five year trial involving almost 10,000 diabetic patients in Australia showed that 115 patients had lower extremity amputations. The risk of first time amputations was 36 percent lower for patients given fenofibrate as compared with placebo.

The conclusion of the study was; “Treatment with fenofibrate was associated with a lower risk of amputations, particularly minor amputations.”

Fenofibrate helps reduce cholesterol and triglycerides in the blood. High levels of these types of fat in the blood are associated with an increased risk of atherosclerosis (clogged arteries) that can delay or prevent wound healing in the patient with diabetes.

Fenofibrate is used to treat high cholesterol and high triglyceride levels. It is used in combination with a diet low in cholesterol and saturated fat. You should not use fenofibrate if you have: hepatitis or cirrhosis of the liver; severe kidney disease; or gallbladder disease. The brand names for fenofibrate are: Antara, Fenoglide, Lipofen, Lofibra, TriCor, and Triglide.

-drhinkes