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RE: [IP] A1c refetence diferentiation question...



Hi mark,

 > This morning, I saw the CDE working with
 > my Endo.  The equipment looked IDENTICAL
 > between my GMP & CDE/Endo equipment.

You mean they used in-office analysers? I have a deep mistrust of
those. Not because they are bad (they are not), but because in my
experience, doctors' offices generally do not have someone whose
clearly defined job it is to clean, maintain, and calibrate blood
analysers.

 > My "routine" doctor arrived at an A1c of
 > 6.9 roughly a MONTH AGO.
 > My CDE [...] said my A1c as-of TODAY was
 > 6.2, with quoted ADA "Goal" of "Below 6.5."

Factoring in an inaccuracy of up to .5 percentage points, that is
possible. Also, keep in mind that the last four weeks make up
around half of your HbA1c.

 > With such differing opinions... How is
 > one to determine what is the best method
 > of treatment???

That's an easy one: Drive your BG as low as you safely can. If
there is room for a blander diet with smaller post-prandial
spikes, and you can tolerate that diet, why not?

 > My GMP doctor says anything below 7 is
 > "Excellent."
 > My Endo says according to the ADA, anything
 > between 6.0 & 6.5 is "Ideal goals".

Part of this is politics. The ADA had a major setback (metabolic
syndrome was co-opted by the cardiologists who now paint
themselves as the go-to people for this lucrative disease), and
tightening the guidelines makes more paid work for their members.
Personally, I keep in mind that an HbA1c between 4.0% and 6.0% is
the normal, non-diabetic, range (the mean is closer to 4% than to
6%, I admit), so I consider anything below 6% to be dandy and up
to 7% as acceptable but perhaps able to be improved.

But do remember that current research also points to BG variance
as an issue; a low average (HbA1c) with major spikes may be worse
than having a little increased HbA1c with a smoother distribution
of BGs.

 > If parent's or "close friends" want to
 > compare...  How do you determine either
 > which source is correct?

You do not. At best you can compare results that came from the
same lab, run on the same machine, after the same calibration.

That said, the differences between labs used to be *much* greater;
getting them to below half a percentage point took years of effort
and an expensive standardisation program.

Cheers,
Felix.
.
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