Goodbye A1c, Hello ABG?

Here’s a bit of news from the 2007 ADA Conference last week that I could swear we heard there last year: The world of A1c is supposedly about to change… being replaced by a revolutionary new measure called the ABG (Average Blood Glucose).

A1c_pic_2 Physicians are apparently conducting “a major study” to demonstrate that the new test is indeed superior.

But the experts I’ve queried said they don’t like the concept at all, and that the new unit measure — internationally recognized SI units — will be extremely confusing.

Seeing as I’m out of pocket at the moment, I haven’t been able to dig up too much more on this new test just yet. Anybody have anything to add to the ABG vs. A1c discussion here?

12 Responses

  1. Lottadata
    Lottadata July 2, 2007 at 6:54 am | | Reply

    The A1c corresponds to mean glucose over a large population, but not in individuals. So for a lot of people the new ABG will be completely wrong.

    Anemia throws off the results. So does having certain genetic forms of Hemoglobin. Beyond that, those of us who keep our bgs in the normal or near normal range and test a lot so that we know what our average glucose is often find that the A1c is higher than expected.

    I suspect that is because the averages were established in populations with A1cs mostly 7% and higher and the dynamics may be different when A1c is closer to 5%.

  2. Chris
    Chris July 2, 2007 at 7:38 am | | Reply

    I am meeting with my endo today. She was at the conference. I will see if she has any thoughts and post here.
    Chris

  3. Kevin
    Kevin July 2, 2007 at 8:01 am | | Reply

    Lottadata is right on about the misinformation due to hemoglobin variants and that’s because everyone assumes that a measurement of A1c = a measurement of historical glucose which is not entirely correct. It’s only a measure of the glucose left over within a small fraction of your hemoglobin A and then only within the 1c and not 1d, etc… assuming that everyone has the same hemoglobin signature…which is entirely not true.

    Further, hemoglobin makeup has the potential to change every few years so it’s not even measurable on the same scale within the same person unless you get your A1c on a frequent basis.

    There’s more on this at challengediabetes.com where we discuss the relationship between accurate and strategically timed A1c checks as well as behavioral psychology.

  4. Challenge Diabetes
    Challenge Diabetes July 2, 2007 at 8:11 am | | Reply

    A1c vs. MBG – Not the Real Problem

    I was at ADA recently and there was a heightened presence of A1c testing as a tool in the diabetes kit this year.   Everyone assumes that a measurement of A1c = a measurement of historical glucose which is not entirely correct. Further, hemoglobin ma…

  5. Christine
    Christine July 2, 2007 at 10:04 am | | Reply

    ABG in the medical world means “Arterial Blood Gas” so I’m guessing if it becomes a common lab they will need to name it something else.

  6. Michael Park
    Michael Park July 2, 2007 at 10:09 am | | Reply

    AHH, this is scary.
    HA1c numbers have always been ‘similar’ to MMOL – in as much as having one decimal point. However, the NON-Correlation between the two has always been stressed. It is possible to go back and forth from Hyperglycemia to Hypoglycemia and still have a great A1c.
    From reading the available articles on the internet, it appears they merely want to do the work of a conversion chart.
    A few points:
    1) does it scare anyone else that they are doing the scientific work to calibrate this new nomenclature using CGM technology which is currently unsafe to use without howmany daily calibrations?!?
    2)Are people really wanting to directly correlate the fact that an A1c of 7% is rougly equivalent to walking around with an average blood sugar of ca. 155mg/l? Or will that cause people to feel more guilty.

    Mostly, I’m disappointed – reading the headline, I thought they had developed a NEW TEST, but no, they just want to paint the same test in a new light… a less truthful light.
    Fundamentally, diabetes management shouldn’t be about making sure EVERY sugar check is perfect, it’s about lowering the overall effect that the disease has on your body – precisely what the A1c tests. By painting the lab work as an ‘average’, it puts the emphasis back onto the small scope- which I propose will have negative psychological ramifications.

  7. EmilyS
    EmilyS July 2, 2007 at 10:29 am | | Reply

    From what I read on the Scientific sessions blog, I thought that they were just going to start reporting A1c’s in terms of mg/dL or mmol/L, and that the test itself had not changed. http://adascisessions.typepad.com/weblog/2007/06/an-old-test-wit.html

    I think the actual abbreviation would be ADAG, “A1c Derived Average Glucose”.

  8. Khurt Williams
    Khurt Williams July 2, 2007 at 12:04 pm | | Reply

    It would seem that it’s the same old test with new terminiology.

    Amy, what is so confusing about SI units? Your car engine displacement is measured in litres as is your diet soda and your food intake (grams of carb, protein etc) and medication (mg/dL). The entrire world, except the USA, has used it for years.

  9. AmyT
    AmyT July 3, 2007 at 1:11 am | | Reply

    LOL, Khurt – most of the world uses the metric system, too, but somehow we haven’t managed to get on board.

  10. Elizabeth Henry
    Elizabeth Henry July 5, 2007 at 9:48 am | | Reply

    Some good news for diabetics: Chocolate has been studied for a variety of health benefits. An article written in April discussed a study on the beneficial effects of chocolate on diabetics. The study, conducted on obese diabetic mice, reported lower blood glucose and fructosamine levels in mice that were given supplements containing cacao liquor proanthocyanidins (CLPr). Researchers suggest that these supplements may prevent hyperglycemia as well as a diet full of cacao derived foods may offset type 2 diabetes mellitus. More clinical evidence based information is needed in this area.

    Elizabeth Henry
    Natural Standard Research Collaboration
    http://www.naturalstandard.com

  11. Frank Varon DDS
    Frank Varon DDS July 5, 2007 at 11:08 am | | Reply

    Now, I was at that particular ADA session and NO FINAL decision has been made until after the EASD meeting in September as to how and when these changes are to take place. There will be changes but the ADA and the EASD and IFCC have been going at it since this issue was first brought up by the IFCC (lab gods) in 2002. YES, 2002! One MD during the Q&A portion vented his frustration at the quibbling over the delays in confronting the clinical chemistry standardization issue. He was applauded by a large portion of the audience. But I can see both points of view (ADA and EASD) and they are both valid. There will be changes but lets wait until September to see how this is planned on being rolled out.

  12. Eric Jensen
    Eric Jensen July 5, 2007 at 2:22 pm | | Reply

    It seems to me that one interesting thing about all of this discussion about A1c is that everyone agrees that it can be deceptive, since it averages over highs and lows. Before we had an alternative, it was the best we could do. But now that CGMS exists, what we really need is some sort of statistic that takes into account the actual daily variations of blood glucose, and time spent high and low. It’s not a simple blood test, but as CGMS improves (and becomes widespread once it starts to be reimbursed), then it *will* be a simple download/calculation. The interesting clinical challenge will then be what sort of statistic actually correlates well with patient outcomes. Mean blood glucose is a simple one, but probably not the best one, I’d guess.

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