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[IP] a1c tests
There are HbA1c tests and there are HbA1c tests. The tests done in a
physician's office are usually a rapid test that has the same standards for
precision and accuracy as our own BG meters (approx. +/- 20%).
The "gold standard" HbA1c test is by a process called hemochromatography.
It's a moderate/high complexity test that (relatively speaking) not many
labs use. Most of these tests are pretty close, although there are
differences between manufacturers.
The HbA1c by hemochromatography is *the* prognostic test for likelihood of
complications, specifically diabetic retinopathy (which is what the DCCT
studied). It is our personal meters that are the approximation.
Many docs will try to save costs by using either their own equipment, or a
lab that uses a less accurate and precise method for doing the test (this is
more likely a requirement of the insurance provider!). A little research
would be appropriate to find out just what test method(s) are being used for
your records. I think it's appropriate to insist that at least one HbA1c a
year be done by a good laboratory using hemochromatography methods - and
probably to insist that each year the specimen be sent to the *same*
laboratory to eliminate lab procedures and specific manufacturers as factors
in the variability.
Jim Handsfield, PhD, MPH
Our lab does our own tests by hemochromatography and I often check my A1c
there. It is usually dead on balls accurate with Quest diagnostics and I have
also used it for my rats. Retinopathy and nephropathy can progress despite
great A1c values. there are other factors less well understood in the
progression of these diseases. the A1c is often held up as a standard for
patients to match but it is often not the whole story. I agree that bad docs
use this to the exclusion of everything else. a good doc will spend a few
minutes talking to you, look at your eyegrounds, check you thyroid, check your
thyroid, phsically examine you with their hands, perhaps talk with your spouse
or so. check your pulse and blood pressure. Sadly most new docs don't even
know how to examine a patient. the art of physical diagnosis is poorly taught
in med school these days. Most docs look only at lab tests and not the
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