Welcome to the ATTD 2022 Interactive Program

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Displaying One Session

Session Type
Parallel Session
Date
Fri, 29.04.2022
Session Time
09:00 - 10:00
Room
Hall 114

Is POC HbA1c Adequate?

Session Type
Parallel Session
Date
Fri, 29.04.2022
Session Time
09:00 - 10:00
Room
Hall 114
Lecture Time
09:00 - 09:20

Abstract

Abstract Body

Hemoglobin A1c (HbA1c) is used very widely both to monitor patients with diabetes mellitus and to diagnose diabetes. An International Expert Committee recommended that HbA1c ≥6.5% rather than fasting glucose be used to diagnose diabetes (Diabetes Care 2009; 32:1327). Since 2010 when HbA1c was advocated by the American Diabetes Association (ADA) for both screening and diagnosis of diabetes (and endorsed in 2011 by the World Health Organization), there has been a dramatic increase in the use of HbA1c for diagnosis. Initially HbA1c was measured only in central laboratories, but subsequently smaller point-of-care testing (POCT) devices became commercially available to analyze HbA1c in doctors’ offices and clinics. At present, the ADA cautions that POCT devices for HbA1c should not be used for diagnosis. Although several point-of-care HbA1c assays are NGSP-certified, the test is waived in the USA and proficiency testing is not necessary. Therefore, no objective information is available concerning their performance in the hands of those who measure HbA1c in patient samples. Nevertheless, some advocate for use of POCT HbA1c devices for diagnosis and the topic remains highly contentious. Numerous publications have evaluated performance of HbA1c POCT devices, with many shown to have inadequate analytic performance (eg, Clin Chem 2010; 56:44; Clin Chem 2014; 60:1062). The use of HbA1c POCT in diabetes diagnosis has also been addressed in both the clinical and laboratory published literature (eg, Clin Chem 2013; 59:1790; Prim Care Diabetes. 2017;11:248; Ann Fam Med. 2017;15:162; JAMA 2019; 322:1404). This talk will provide a current perspective on these issues.

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Is There Still a Role for Fructosamine, Glycated Albumin, and 1,5 AG?

Session Type
Parallel Session
Date
Fri, 29.04.2022
Session Time
09:00 - 10:00
Room
Hall 114
Lecture Time
09:20 - 09:40

The impact on policy of the changing science in T1D

Session Type
Parallel Session
Date
Fri, 29.04.2022
Session Time
09:00 - 10:00
Room
Hall 114
Lecture Time
09:40 - 10:00

Abstract

Abstract Body

The introduction of the clinical use of HbA1c in the early 1980s was a revolutionary step for the modern management and eventually the diagnosis of diabetes. The use of this objective and relatively inexpensive biomarker allowed both researchers and clinicians to track diabetes control. In fact, the Diabetes Control and Complications Trial (DCCT) would not have been possible if not for the use of HbA1c. The test now is standard of care for all types of diabetes for assessment of glycemic control.

While limitations of HbA1c (anemias, hemoglobinopathies, etc.) have been understood for 40 years, it has been more recently that the real limitations of HbA1c have been reported due to the use of continuous glucose monitoring (CGM). This was first observed in a population with no anemia, renal disease, or liver disease in 2008-an individual with a HbA1c of 9% could have the same mean glucose as someone with a HbA1c of 7%. For a population, the test is robust, but for any given individual, there may be major discordance between mean glucose and HbA1c. While more factors have been found to impact HbA1c since the 1980s, we have also learned that race/ethnicity may impact this biomarker. For example, on average we now know that in African Americans, HbA1c runs 0.4% higher than in Caucasian Americans.

The introduction of glucose management indicator (GMI) has resulted in many clinicians wondering if we need to measure HbA1c moving forward. While using GMI during the pandemic when it was not possible for patients to get blood work was helpful, HbA1c will remain as part of our standard of care. First, the majority of people with diabetes do not use CGM, so GMI is not possible. Still, in an ideal world it would be good to know if there is discordance between mean glucose and HbA1c tested with a one-time professional HbA1c for at least 14 days. Secondly, many clinicians and patients feel HbA1c is an important piece of information they want for routine clinic visits. It should also be noted that regulatory agencies are still dependent on HbA1c as an objective measure to confirm the efficacy of a pharmaceutical therapy. Still, it is also true HbA1c does not provide the granularity of someone’s diabetes control, particularly as it pertains to hypoglycemia.

After four decades of the use of HbA1c, it is not realistic that it will go away and more importantly, it will continue to have a role in the immediate future. Given the cost of CGM, it likely will continue to be used in the long-term future too.

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