This question is to medical doctors treating diabetic patients.I consider that if Hb1ac is in normal range there's no further test related to DM of course ophthalmologic, neurologic and nephrologic follow up procedures must be done always as necessary.
The Hb1Ac is the behavior of blood glucose at intervals of 3 months, but is making measurements at shorter intervals you will have only the overlapping of these intervals, which should be considered when analyzing the values.
Eduardo is absolutely correct. The HbA1c measures diabetes control over the past 3 months, so taking measurements more often will not only waste limited resources, but it won't provide a clear indication of changes in control. Have you considered taking blood glucose measurements? They can be repeated as often as several times per day...
Ariel
Ariel fine. As I work with physical exercise in diabetic patients realize glucose measurements in fasting every 15 to 30 days days in portable equipment. They are low-cost measures and allow me to observe the effect of exercise. Also allow measurements before and after the exercise session.
As I understand for follow up with hb1ac is generally done once in three months as the most common but it has to be noticed that :
"Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control." From : http://www.diabetes.co.uk/what-is-hba1c.html & many other sources.
" When should HbA1c be ordered?
HbA1c reflects average glycaemia over the preceding 6–8 weeks. The test is subsidised by Medicare up to four times in a 12 month period.1 In some patients, HbA1c may be measured more frequently than 3 monthly to closely monitor glycaemic control (eg. in pregnancy when up to six tests in a 12 month period can be subsidised).1 The Service Incentive Program for diabetes care requires at least one HbA1c measurement per year. It is suggested that HbA1c is done every 6 months if meeting target, or every 3 months if targets are not being met or if therapy has changed.2" FROM : http://www.racgp.org.au/afp/2012/januaryfebruary/hba1c-and-monitoring-glycaemia/
That's right. The HbA1c measures average diabetic control over a 3 month period. There is no value in taking additional measurements within that time-frame. If you want to measure diabetes control more frequently you should consider blood glucose monitoring, as is expected for those patients on insulin, or are known to be out of control.
Sinan,
You may find this paper helpful. I wrote it several years ago and it has received alot of attention from practitioners over the years.
Ariel
Article A Conceptual Framework for Targeting Prediabetes with Lifest...
If the patient is treated with insulin or sulfonylurea that may cause hypoglycaemia that may be a reason to do additional blood glucose measurements, but if not, HbA1c measurements every 2-3 months should be sufficient. Little evidence that additional measurements lead to better clinical outcomes. If used, they should have a clear goal (such as following the effect of exercise such as Eduardo suggests).
Monitoring of HbA1c may be great for physicians in setting targets for diabetic control. Blood glucose measurements, such as fasting and post-prandial sugars, are much more useful in individual patients who have to keep a close eye of their meals, their exercise habits, their medications, and less frequent events like illness, changed eating habits while travelling or 'splurging' at that party or festival yesterday.
Patients can't be 'partners' in effective diabetic care if the only moniyor of their blood sugars is done by their physician once every three months.
When combined with fasting glucose levels and in the absence of frequent hypoglycemia HbA1c is quite sufficient. Every two months seem to often. If patient have stable daily fasting and postprandial glucose levels time between two HbA1c measurements may be even prolonged but there are patients with unstable glucose levels during day ( hypo/hyper) with good HbA1c .That is why just HbA1c will not be enough
Glycosylated hemoglobin HbA1C alone isn't usifull for follow up diabetic patients treated with insulin or hypoglycemic agents. However in addition to blood sugar, HbA1C can be measured each three months for beter evaluation.
Measuring HbA1C every 2 months can be used if significant variations were expected to be observed from the previous reading.
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