The hemoglobin A1c test, often called the HbA1c, is the gold standard of all diabetes blood sugar testing. The HbA1c tests for a blood hemoglobin marker that gives a picture of your average blood sugar for the past three months. The American Diabetes Association (ADA) recommends at least two of these tests each year, and more often if you are having difficulty maintaining your blood sugar level within your target range.

The International Diabetes Federation and American College of Endocrinology recommends the HbA1c level of diabetics be below 6.5 per cent. But is this the best goal? Let us look at some of the evidence and find out.

Studies have shown than a HbA1c level even below 6.0% shows there is an increased risk of cardiovascular disease, heart attack and stroke. Once the American Diabetes Association advised people with type 1 or type 2 diabetes they were considered to be under good control when their reading was under 7.0%. Now, new research shows the goal should be closer to 6.0% and even lower. The reading of a non-diabetic is 5.0% and less.

Studies of adults show those with a lower HbA1c level experience better levels of psychological well being including:

• less anxiety
• less depression
• improved self-confidence and
• a better quality of life

Many health care providers set goals for their patients 1 per cent higher than normal. Do you know the average reading for a person with diabetes in the United States is 10.0%… this is far too high. The higher the HbA1c level the higher the risk of damage to your blood vessels… this is where diabetic complications start.

Set up your own personal goal for your HbA1c level in collaboration with your health care provider. This goal will be different for each person and probably different at various stages in your life. It can be difficult to maintain the same HbA1c level at times when you are coping with difficulties at home or work. Also ask your health care provider for the comparison between your proposed HbA1c level and blood sugar levels, as this gives you an idea of the relationship between this test and your blood sugar tests at home.

By competing with yourself and setting a realistic goal you will have a fair chance of avoiding or certainly delaying diabetic health complications.

Metabolic syndrome increases the risk for microalbuminuria more than three-fold in Middle-Eastern people with Type 2 diabetes, an Iranian study shows.

A number of reports have demonstrated an association between the metabolic syndrome and microalbuminuria, but this relationship has been less well studied in people with Type 2 diabetes.

Alireza Esteghamati and co-workers (Tehran University of Medical Sciences, Tehran, Iran) recruited 800 consecutive adults with Type 2 diabetes attending for follow-up visits at an endocrinology clinic in Tehran.

Metabolic syndrome was defined by the International Diabetes Federation (IDF) criteria, with the exception of waist circumference, which was defined by recently established cut-offs for Middle-Eastern populations of 91.5 cm for men and 85.5 cm for women (compared with IDF values of 94 cm for men and 80 cm for women).

Microalbuminuria was defined by urinary albumin excretion between 30 and 299 mg/day on at least two of three occasions. Patients with macroalbuminuria and those with poor renal function were not included.

In this study, 645 patients had metabolic syndrome and 155 did not. Microalbuminuria was present in 237 (29.6%) patients with metabolic syndrome, and increased in prevalence with increasing numbers of metabolic abnormalities, report the authors in the journal Acta Diabetologica.

When patients were divided into those with (237 patients) and without (563 patients) microalbuminuria, metabolic syndrome was significantly more common among patients with microalbuminuria (90.3%) than those without (76.6%) even though there was no significant difference between the groups in terms of age, gender, and renal function.

Multivariate regression analysis revealed metabolic syndrome was the strongest correlate of microalbuminuria with an odds ratio of 3.3. This was followed by HbA1c and diabetes duration, which were both associated with a 1.3-fold greater risk for microalbuminuria.

The authors acknowledge that, as a cross-over study, the results do not allow them to draw any cause-and-effect conclusions, but suggest that “the presence of metabolic syndrome in a Type 2 diabetic patient is an independent alarm for renal involvement.”

“We expect interventional measures that improve metabolic control to aid in regression of microalbuminuria,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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