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September 2, 2003

A1c (Glycohemoglobin, HgbA1c), Diagnosis and Symptoms

Question from Oak Hill, Virginia, USA:

I am a 40 year old male who exercises regularly, eats healthy, has no known other health problems, stands 5 feet 9 inches tall, and weighs 165 pounds. About a month ago, I was not feeling well with flu-like symptoms (very fatigued, no appetite, persistent headache, and fever) so I went to my doctor. (These symptoms still remain.) He ordered blood tests, and my CBC was normal, my glucose was 100 mg/dl [5.6 mmol/L], and my A1c was 5.9%. My doctor sent me a note recommending I come back to discuss these test results. The note from the lab said that an A1c over 6% was considered positive for diabetes, but I don't see that I have any of the risk factors for developing diabetes. Could there be other factors that resulted in my high A1c results that I should be investigating?

Answer:

Hemoglobin A1c, though very effective for measuring control of diabetes, is not a definitive diagnostic marker for diabetes mellitus. The lab itself could be suspect. I would ask your physician to repeat the test and use a different lab. Diagnostic markers used are C-peptide and insulin levels, insulin antibody levels and various immunological markers. The best test would be a one or two-hour postprandial glucose. Other risk factors include family history.

If your glucose is within normal parameters and no other abnormalities, I generally ask my patients to monitor their diet, exercise and monitor their glucoses with a meter.

ABS