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Monday, January 4, 2010

[diabetes_int] Digest Number 8514

Messages In This Digest (8 Messages)

Messages

1a.

New ADA Guidelines Urge A1C Test for Diabetes Diagnosis

Posted by: "rogerhlmn@aol.com" rogerhlmn@aol.com   rogerhlmn

Sun Jan 3, 2010 2:52 am (PST)




From "Drs from FDA & NYU Langone Medical Center" via "Diabetes In Control" newsletter ---
To be published in "January 2010, Diabetes Care" [may have already been published]

Something good coming from ADA! My hats off to them for this!!! [You haven't heard me say anything like that before!]
Better late ...!

Using the HbA1c to diagnose DM has always seemed like a good idea [to me anyway], and now it's time has come!

But also, the ADA seems to have come around to finally agreeing with what Dr Bernstein has said for years, going mostly unheard, that the "true non-diabetic has a HbA1c in the 5% range. They've supported this with their new recommendations that pre-diabetes will be diagnosed as low as HbA1c of 5.7% with DM being diagnosed at 6.5%.

I wonder if I might have been diagnosed earlier [and control would have been easier] if HbA1c had been the criteria. At diagnosis, my HbA1c was 15.5% and surely the previous year it would have shown some elevated level, or even what about years before that? Water under the bridge...!

Whole article at:

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=8758&catid=1&Itemid=17

Roger, T2, etc...
_________________________________________

It's Final: New ADA Guidelines Urge A1C Test for Diabetes Diagnosis

The ADA will publish the new guidelines in the January issue of Diabetes Care. The A1c blood test may catch Type 2 diabetes, prediabetes sooner, with no fasting.

... the American Diabetes Association is promoting a more prominent role for the hemoglobin A1c blood test in the diagnosis of Type 2 diabetes and prediabetes ...

... the A1c blood test measures average blood sugar levels for the previous two to three months. The new guidelines call for the diagnosis of Type 2 diabetes at A1c levels above 6.5 percent, and prediabetes if the A1c levels are between 5.7 and 6.4 percent ...

... the A1c isn't necessarily superior to other methods used to detect Type 2 diabetes and prediabetes, such as fasting blood sugar tests and the oral glucose tolerance test, but it is easier and more convenient for people because you don't have to fast before an A1c test ...

... In the past, the A1c wasn't recommended for use in the diagnosis of diabetes because the test wasn't standardized from lab to lab, according to the ADA. That means a reading of 6.5 percent at one lab could have been 6.3 percent at another. Now, the test is highly standardized, according to the ADA, making it a useful tool for detecting diabetes and prediabetes without the need for fasting ...

... A1c measures the percentage of hemoglobin ... in the blood that is glycated. Glycated hemoglobin is hemoglobin that has a blood sugar molecule attached to it, which happens when blood sugar levels are higher than they should be.
Generally, people without diabetes have an A1c level of less than 5 percent ...

... may help diagnose more people with Type 2 diabetes and prediabetes sooner than they might have been in the past ...

... "People don't need to be fasting for an A1c, and there are fewer variables that can affect the outcome of the A1c," ...

"I think diabetes is grossly underdiagnosed and prediabetes, even more so ...

[Non-text portions of this message have been removed]

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Messages in this topic (4)
1b.

Re: New ADA Guidelines Urge A1C Test for Diabetes Diagnosis

Posted by: "whimsy2" whimsy2@hevanet.com   vabbott1

Sun Jan 3, 2010 6:34 am (PST)



Hmmm... I wonder how long ago the A1C was standardized? I certainly
don't remember reading anything of the sort in any diabetes-related news
sites. And it's certainly newsworthy.
Vicki

----- Original Message -----
From: <rogerhlmn@aol.com>
To: <diabetes_int@yahoogroups.com>
Sent: Sunday, January 03, 2010 2:51 AM
Subject: [diabetes_int] New ADA Guidelines Urge A1C Test for Diabetes
Diagnosis

>From "Drs from FDA & NYU Langone Medical Center" via "Diabetes In
>Control" newsletter ---
To be published in "January 2010, Diabetes Care" [may have already been
published]

Something good coming from ADA! My hats off to them for this!!! [You
haven't heard me say anything like that before!]
Better late ...!

Using the HbA1c to diagnose DM has always seemed like a good idea [to me
anyway], and now it's time has come!

But also, the ADA seems to have come around to finally agreeing with
what Dr Bernstein has said for years, going mostly unheard, that the
"true non-diabetic has a HbA1c in the 5% range. They've supported this
with their new recommendations that pre-diabetes will be diagnosed as
low as HbA1c of 5.7% with DM being diagnosed at 6.5%.

I wonder if I might have been diagnosed earlier [and control would have
been easier] if HbA1c had been the criteria. At diagnosis, my HbA1c was
15.5% and surely the previous year it would have shown some elevated
level, or even what about years before that? Water under the bridge...!

Whole article at:

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=8758&catid=1&Itemid=17

Roger, T2, etc...
_________________________________________

It's Final: New ADA Guidelines Urge A1C Test for Diabetes Diagnosis

The ADA will publish the new guidelines in the January issue of Diabetes
Care. The A1c blood test may catch Type 2 diabetes, prediabetes sooner,
with no fasting.

... the American Diabetes Association is promoting a more prominent role
for the hemoglobin A1c blood test in the diagnosis of Type 2 diabetes
and prediabetes ...

... the A1c blood test measures average blood sugar levels for the
previous two to three months. The new guidelines call for the diagnosis
of Type 2 diabetes at A1c levels above 6.5 percent, and prediabetes if
the A1c levels are between 5.7 and 6.4 percent ...

... the A1c isn't necessarily superior to other methods used to detect
Type 2 diabetes and prediabetes, such as fasting blood sugar tests and
the oral glucose tolerance test, but it is easier and more convenient
for people because you don't have to fast before an A1c test ...

... In the past, the A1c wasn't recommended for use in the diagnosis of
diabetes because the test wasn't standardized from lab to lab, according
to the ADA. That means a reading of 6.5 percent at one lab could have
been 6.3 percent at another. Now, the test is highly standardized,
according to the ADA, making it a useful tool for detecting diabetes and
prediabetes without the need for fasting ...

... A1c measures the percentage of hemoglobin ... in the blood that is
glycated. Glycated hemoglobin is hemoglobin that has a blood sugar
molecule attached to it, which happens when blood sugar levels are
higher than they should be.
Generally, people without diabetes have an A1c level of less than 5
percent ...

... may help diagnose more people with Type 2 diabetes and prediabetes
sooner than they might have been in the past ...

... "People don't need to be fasting for an A1c, and there are fewer
variables that can affect the outcome of the A1c," ...

"I think diabetes is grossly underdiagnosed and prediabetes, even more
so ...

[Non-text portions of this message have been removed]

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Messages in this topic (4)
1c.

Re: New ADA Guidelines Urge A1C Test for Diabetes Diagnosis

Posted by: "gretchen" gretchenb@hughes.net   gretchen4c

Sun Jan 3, 2010 8:22 am (PST)



> Hmmm... I wonder how long ago the A1C was standardized? I certainly
> don't remember reading anything of the sort in any diabetes-related news
> sites. And it's certainly newsworthy.

See http://www.mendosa.com/standardizing.htm

Several years ago, the various expert bodies rejected the idea of using A1c
to diagnose because there's a lot of variation, not only in how the tests
are performed but in individual results. However, none of the other
screening criteria are perfect either.

Gretchen

http://wildlyfluctuating.blogspot.com
http://www.healthcentral.com/diabetes/c/5068

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Messages in this topic (4)
1d.

Re: New ADA Guidelines Urge A1C Test for Diabetes Diagnosis

Posted by: "Joseph Navarro" demokratia@cox.net   demokratia2003

Sun Jan 3, 2010 2:28 pm (PST)



>Roger wrote:
>Using the HbA1c to diagnose DM has always seemed like a good idea
>[to me anyway], and now it's time has come!

----------------------------------------------------------
The DCCT trials gave control purpose. The message was if you
control, there is a payoff.
It seems that the A1C scores had some relationship complications.
Once our chronic disorder starts complications can surface if too
much glucose courses our circulation. The emergence of the meter,
the DCCT standardization establishing some statistical relation of
A1C scores and complications established a way of measuring that is
more accurate than the rough strips that were used before the meters.
I have never seen studies of the accuracy of lab tests in measuring
bgs or even seen the raw data that sets measures of relation between
bg averages and complications. A certain amount of faith in these
figures is assumed though seeing the raw data would be better.

It is also interesting that Europeans want a different way of
measurement than the A1C.

The thing about statistical averaging and such is that bg scores are
averaged and boundaries are established in terms of where the bg
range is normal, where diabetic but these crunched numbers need to be
used with caution because of the individual nature of diabetes.

The diabetic condition of a diabetic is arrived at by several ways of
measurement, some qualitative measurement. Just looking at the
diabetic, talking to them, examining their body, their medical
history. Reviewing their diet, exercise, etc. Bg. scores are good
and one day if continuous meters are perfected they may give us
better insight to more precise bg scores. It is hard to measure
just how much harm a high bg will do to the complications, the
measures do not point to highly exact degrees of harm for the various
complications and this is complicated further by the Unfair nature of
complications, that some diabetics get them less than others or get
more harm than others. Variation differs from diabetic to diabetic.
So that measuring will always have some limits unless our researchers
start making some incredible breakthroughs.

There have been some strange statistical revelations: Europeans tend
toward type 1 diabetes while type 2s tend toward third world
countries. In reality, there must be a very large number of
different kinds of diabetics and if this is true would applying a
standardized hemoglobin A1C fit these different kinds of diabetes?
We need to classify the new breed of diabetic children and maybe
their diabetic physiology is different as their anomaly in getting
diabetes in childhood?

Joe

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2.

Diabetes Lowers Protective Effects of HDL

Posted by: "rogerhlmn@aol.com" rogerhlmn@aol.com   rogerhlmn

Sun Jan 3, 2010 3:07 am (PST)




From "Journal of the American Heart Association. Dec. 2009" via "Diabetes In Control" newsletter ---

Whole article at:

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=8763&catid=1&Itemid=17

Roger, T2, etc...
_______________________________________________

Diabetes Lowers Protective Effects of HDL

High-density lipoprotein (HDL), known as "good" cholesterol, isn't as protective for people with Type 2 diabetes, according to new research.

... high levels [of HDL] are associated with a lower risk of heart disease. HDL also helps protect blood vessels by reducing the production of damaging chemicals, increasing the vessels' ability to expand, and repairing damage to the vessel lining ...

... investigators found that the protective benefits on blood vessels were "substantially impaired" in HDL from the diabetic patients ...

... to receive either a placebo or extended-release niacin (1500 milligrams/day), a medication that raises HDL cholesterol while reducing other blood fats. After three months, patients receiving extended-release niacin had increased HDL levels, and markedly improved protective functions of HDL in laboratory testing as well as improved vascular function.

... more research is needed to determine if niacin should be recommended for diabetic patients ...

[Non-text portions of this message have been removed]

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Messages in this topic (1)
3a.

Sad news about Ron Sebol

Posted by: "Laura Kressler" toaddoc@verizon.net   toaddoc1

Sun Jan 3, 2010 5:55 pm (PST)



I have heard that Ron Sebol, the moderator and co-owner of the DSM
list, has passed away. Ron was a phenomenal person who devoted much
of his life to helping other diabetics achieve control. His
background in engineering gave him the skills needed to approach this
task with both precision and great care.

Ron cared so deeply for all of the people he met and helped over the
years. I enjoyed my talks with him and regret greatly that we never
managed to get our schedules together for that lunch we talked about
despite living quite close to each other.

Even though I rarely participated in the discussions, I always read
the list and I will miss his posts which were always business like,
information packed, painfully accurate and, as we all know, never
ending. It always amused me when Ron would loosen up a bit and post a
somewhat personal, humorous post. It gave you a small glimpse of his
true personality which was a caring, generous, genuine person with a
great sense of humor. Offline, his posts were always entertaining.

I wanted to pass on this sad news because I know Ron touched many
lives. He will be greatly missed. The DSM list will not be the same
without him.

Laura K.

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Messages in this topic (3)
3b.

Re: Sad news about Ron Sebol

Posted by: "George Elting" justgeo1@comcast.net   justgeo1

Sun Jan 3, 2010 6:05 pm (PST)



Bummer... another wonderful human being has left... he will definitely be
missed.

_____

From: diabetes_int@yahoogroups.com [mailto:diabetes_int@yahoogroups.com] On
Behalf Of Laura Kressler
Sent: Sunday, January 03, 2010 5:55 PM
To: diabetes_int@yahoogroups.com
Subject: [diabetes_int] Sad news about Ron Sebol

I have heard that Ron Sebol, the moderator and co-owner of the DSM
list, has passed away. Ron was a phenomenal person who devoted much
of his life to helping other diabetics achieve control. His
background in engineering gave him the skills needed to approach this
task with both precision and great care.

Ron cared so deeply for all of the people he met and helped over the
years. I enjoyed my talks with him and regret greatly that we never
managed to get our schedules together for that lunch we talked about
despite living quite close to each other.

Even though I rarely participated in the discussions, I always read
the list and I will miss his posts which were always business like,
information packed, painfully accurate and, as we all know, never
ending. It always amused me when Ron would loosen up a bit and post a
somewhat personal, humorous post. It gave you a small glimpse of his
true personality which was a caring, generous, genuine person with a
great sense of humor. Offline, his posts were always entertaining.

I wanted to pass on this sad news because I know Ron touched many
lives. He will be greatly missed. The DSM list will not be the same
without him.

Laura K.


[Non-text portions of this message have been removed]

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Messages in this topic (3)
3c.

Re: Sad news about Ron Sebol

Posted by: "whimsy2" whimsy2@hevanet.com   vabbott1

Sun Jan 3, 2010 7:35 pm (PST)



I believe I was the first person (besides himself) to use Ron's program,
and although it has required numerous adjustments over the years, I have
absolutely no doubt that without his help I would be a "brittle"
diabetic. I certainly wouldn't have reached 13 years of diabetes with no
diabetes-related complications.

So I truly do owe him my excellent quality of life.

The last time he tried to make adjustments for me, my parameters kept
changing so often that he essentially threw up his hands and gave up,
more or less. I may have been the only person to have stymied him, but
this gave me no pleasure. Still and all, I use his personalized program
daily with at least moderate success, and as I use it, I will always
think of him and the work he did to create this program for me.

And my A1Cs have continued to remain no higher than 6.2 in the 12 or so
years I've used it.

He was difficult, exacting and sometimes cranky, but he had a wonderful,
dry sense of humor and was incredibly generous with his time.

Although he helped only an infinitestimal percentage of diabetics, those
of us included in that cohort feel incredibly lucky.

He will be sorely missed.

Vicki

----- Original Message -----
From: "Laura Kressler" <toaddoc@verizon.net>
To: <diabetes_int@yahoogroups.com>
Sent: Sunday, January 03, 2010 5:54 PM
Subject: [diabetes_int] Sad news about Ron Sebol

>I have heard that Ron Sebol, the moderator and co-owner of the DSM
> list, has passed away. Ron was a phenomenal person who devoted much
> of his life to helping other diabetics achieve control. His
> background in engineering gave him the skills needed to approach this
> task with both precision and great care.
>
> Ron cared so deeply for all of the people he met and helped over the
> years. I enjoyed my talks with him and regret greatly that we never
> managed to get our schedules together for that lunch we talked about
> despite living quite close to each other.
>
> Even though I rarely participated in the discussions, I always read
> the list and I will miss his posts which were always business like,
> information packed, painfully accurate and, as we all know, never
> ending. It always amused me when Ron would loosen up a bit and post a
> somewhat personal, humorous post. It gave you a small glimpse of his
> true personality which was a caring, generous, genuine person with a
> great sense of humor. Offline, his posts were always entertaining.
>
> I wanted to pass on this sad news because I know Ron touched many
> lives. He will be greatly missed. The DSM list will not be the same
> without him.
>
> Laura K.
>
>
>
>

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Messages in this topic (3)
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