Patients with Diabetes - Best Way to Follow?

Heartwire 2007. © 2007 Medscape July 3, 2007(Chicago, IL) - A small but clinically relevant change appears to be coming to the management of patients with diabetes mellitus. Hemoglobin A1c (HbA1c) levels, used to assess long-term glycemic control, might soon be replaced with average blood glucose, a change experts say will add clarity for diabetic patients looking to manage their disease. Discussing the expected change here at the American Diabetes Association (ADA) 2007 Scientific Sessions last week, Dr David Nathan (Harvard University Medical School, Boston, MA) said that "patients have a glucose problem, not a hemoglobin problem" and that fasting glucose would be a better measure, as this new value "would help them understand their disease better." Reporting glycohemoglobin results as an A1c-derived average glucose, said Nathan, would have the advantage of reporting chronic glycemia in the same units as the patients' self-monitoring of daily glycemia. Nathan is the lead investigator of the international ADAGE trial, a study performed to confirm the relationship between average glucose and HbA1c levels. To date, only a few studies with relatively infrequent glucose monitoring support a strong mathematical relationship between average glucose and HbA1c, but if a switch is to be made from HbA1c to average glucose levels, an international study is needed to establish the relationship across diabetes type, races, and ethnicities, said Nathan.