Hemoglobin A1c and the Estimated Average Glucose

International Expert Committee Report on the Role of the A1c Assay in the Diagnosis of Diabetes

July 2009

Very recently HbA1c was endorsed by an international expert committee to be used in the diagnosis of diabetes.  A cutpoint of 6.5% was recommended based on the sensitivity and specificity of several studies.  An elevated HbA1c should be confirmed with a repeat measurement except in those individuals who are symptomatic and also have an increased plasma glucose over 200 mg/dL.  The terms pre-diabetes, impaired fasting glucose, and impaired glucose tolerance will be phased out to eliminate confusion.  Patients who have an HbA1c >=6.0  but <=6.5% are still considered at risk for developing diabetes in the future.  There is no endorsement of HbA1c for diabetes screening at this time.

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International Expert Committee Report

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Jump to section:

• Introduction
• US Diabetes Prevalence
• Diagnosis of Diabetes
• Categories of Glucose Values
• Importance of Diagnosis
• Role of the Laboratory
• Fasting Plasma Glucose
• Fasting Plasma Glucose
• Hemoglobin A1c (HbA1c)
• Glycation
• HbA1c Concentration
• Diabetes Treatment Goals
• HbA1c Methods
• Hemoglobin Variants
• Hemoglobinopathies
• Reporting HbA1c as an eAG
• HbA1c and Average Glucose
• Derivation of Estimated Average Glucose (eAG)
• HbA1c/eAG Table
• Limitations
• Endorsement of eAG
• HbA1c for Diagnosis of Diabetes
• Disadvantages
• International Expert Committee Report on the Role of the A1c Assay in the Diagnosis of Diabetes
• HbA1c at Mayo Clinic
• Conclusions
• Questions?