FUDiabetes

What do you consider to be a diagnostic A1C

Okay, I’m asking this for a friend whose A1C’s seem to be behaving a little badly of late. Any thoughts about what measurement would prompt you to request antibody testing?

My thoughts are that the current trend is to diagnose way way too readily and that it’s largely internet driven hysteria. Even just a few years ago when I was diagnosed they didnt start throwing around the D word unless your a1c was above 6.5 and 6.0-6.5 they just considered prediabetes.

Unless they’re seeing remarkably high fasting numbers and significantly elevatef a1c… really no point in worrying themselves

Antibody testing a non diabetic isn’t meaningful…

I can certainly see your point, @Sam, but by this standard, I wouldn’t have been diagnosed until my diabetes was much more advanced. Highest A1C I ever had was a 5.5 gestational. I was insulin-dependent from the start with use that has progressed over time, of course. I am grateful to have had a diagnosis at the emergent point, rather than at the DKA point–or even at the elevated A1C point.

Except in the case of our kids with Trialnet? Not being snarky here. Really am curious about when antibody testing becomes meaningful.

FWIW, said friend is maintaining a fairly strict diet and exercise regimen.

That’s just for research purposes… not for treatment. If they start showing antibodies it’s just all recorded and then they’re monitored to see if and when what types of antibodies or combinations leads to developing diabetes…

Antibody testing a non diabetic isn’t meaningful…

I disagree. I think that – especially in an adult – testing antibody positive would conceivably put you in the running for several clinical trials which are testing treatments with minimal side effects. The upside is they might work somewhat. The downsides are pretty minimal for at least a few of these treatments. So I would always err on the side of finding out about antibodies sooner, even if there’s nothing well-established that can be done for people right now.

BTW, testing positive for two different antibodies is now considered diagnostic of T1D, so if someone did test positive for two, that’s basically a 100% chance they will develop symptomatic diabetes down the road. That’s what TrialNet has shown.

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@Tia, do you have any thoughts on what A1C number would prompt you to request testing?

Like you, @Irish, mine was caught early - not sure how long it would have been if my doctor had waited until my A1c was higher (5.8 at diagnosis). Personally, I would think A1c in the pre-diabetic range warrants further testing to see why it’s up there (I’d probably be more aggressive with family history of t1 - like if A1c is getting higher each year but still not out of normal range, maybe try to find out why).

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I hadn’t heard that , is there a source I can read up on it?

I think an A1C above 5.6 warrants testing. If an A1C warrants treatment (i.e. even if it’s for T2) then I think T1 should be ruled out first.

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yes, let me dig it up. I saw a really clear survival plot in a presentation I think from UC Denver on TrialNet results.

ETA: Here’s one study/statement

Okay still Googling for that one presentation but here’s a laymen’s article about the new diagnostic staging.

https://asweetlife.org/the-stages-of-type-1-diabetes-it-starts-earlier-than-we-thought/

“While someone who tests positive for one autoantibody may never develop the disease, someone with multiple autoantibodies has a lifetime risk of 100%.”

Also in this article it says: “Individuals with antibodies to more than one islet autoantigen are at greatest risk and there is an increasing body of evidence that, in the long term, almost all people with multiple autoantibodies seem likely to develop diabetes.” And then there are several sources linked.

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Thanks I’ll look into these. I’m particularly interested because I tested positive for gad65 twice myself… but both times with only a level of 0.3 (don’t know the units) and have not been able to find much info about at what levels positives are significant, what the margins of error, etc… and my own doctor directly contradicted himself on the subject at first saying “well it’s not that accurate of a test and yeah the level really matters in whether it’s significant”. Then the next appointment said “well it’s just a little tiny bit positive but it’s still positive just like a little tiny bit HIV positive is still positive”. Sometimes his mouth outruns his brain

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i would consider a a1c of 5.0 or higher i belive non diabetics should have a lot lower a1c

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But that would mean something like 80% of the adults in the USA are diabetic… I would agree that if across the board human beings were eating healthy diets and exercising that most non diabetic A1Cs would be below 5.0… but I don’t even think the average non diabetic A1C is that low in our current world (speculating)

Mayo Clinic:

For someone who doesn’t have diabetes, a normal A1C level is below 5.7 percent.

When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate occasions indicates you have diabetes.

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I think above 5.6 is considered pre-diabetes, and at least with my mom, her doctor has recommended treatment (such as metformin or in her case, weight loss) at that level.

It varies from one locale and one lab to another, but in my observation no labs flag results of less than about 5.6 in any way shape or form (except for possibly in pregnancy?) yet the internet is full of people with untreated a1c of 5.1 talking about their diabetes

I should probably clarify also that I wasn’t diagnosed because of my A1C. I was diagnosed, because I spectacularly failed the GTT. And required massive amounts of insulin to maintain a bg under 120.

That, and I still needed insulin after the adorable baby’s delivery.

Still, I credit an early diagnosis in part with my ability to manage decently thus far. And, who knows, perhaps that early diagnosis has prolonged some pancreatic beta cell function.

Same. I had high fasting, positive GAD65 antibodies, and other things that indicated strain on my beta cells (can’t remember exacts tests atm). Pregnancy made things super crazy - I was at a 1:5 ICR right from the beginning when I finally got insulin while pregnant; hadn’t needed any before. Thankfully I don’t need as much now.

How high did your bg go in the gtt?