The Dumbest Idea Ever
“The reporting of A1C – using that name- in percentage units, such as a goal of under 7 percent, has always presented problems in doctor-patient communications. Yet this is the single most important assay in diabetes today because it assesses both chronic glucose control and risk for complications” said David Nathan, MD, Professor of Medicine, Harvard Medical School. Dr. Nathan went onto state “The ability of physicians to report A1C results in the same units that they are using for self-monitoring – so they are using the same language to communicate glucose goals – will certainly advance patient education.”
Dr. Nathan made these comments in response to perhaps the dumbest idea ever floated- reporting A1C results in new average glucose (AG) units. Not sure where Dr. Nathan is getting his information but A1C as it stands is the ONLY number patients understand. Someone will need to explain to Diabetic Investor how taking a simple easy to understand number and converting it to a new number will help patient education. First off converting A1C to AG assumes patients monitor their glucose levels on a regular basis and that patients understand what these numbers mean, something that just doesn’t happen out in the real world. In fact, one of the reasons the majority of patients fail to monitor their glucose levels is they don’t understand what the number means.
Interestingly there is a growing body of evidence that regular glucose monitor by non-insulin patients does not result in better outcomes. According to the results of the DiGEM trial, a year long study designed to determine whether regular monitoring, either alone or with additional instruction in incorporating test results into self-care, is more effective than standard medical care in improving glycemic control in people with non-insulin treated type 2 diabetes, found that there was no correlation between more frequent monitoring and improvements in A1C. According to Andrew J. Farmer, FRCGP, DM, University Lecturer, University of Oxford, and Principal investigator of DiGEM, “No self-monitoring was compared to two different intensities of self-monitoring, and no clinically significant different reductions were seen in results on A1C tests. Further, no additional effect of a more intensive self-monitoring was observed.”
So besides not understanding what these numbers mean, according to the DiGEM test results are basically worthless as they don’t lead to better outcomes even when the results are incorporated into treatment. Therefore it makes perfect sense to change an easy to understand test result to a number that most patients don’t understand and is practically worthless. How changing A1C to AG will improve patient education is anyone’s guess.
This line of thinking is further evidence of just how far out of touch people from academia can be with reality. This same line of thinking is used by the many companies trying to develop a non or minimally invasive glucose monitor. These companies falsely believe that if the test is completely painless patients will test with greater frequency. For years Diabetic Investor has been saying the so-called pain factor is vastly over-rated when it comes to why patients don’t test regularly. The simple facts are for the majority of patients they don’t understand what the results mean and there is no action step taken based on the results. Why would anyone do something that does not add value to their lives or improve their outcomes?
Back when Metrika first came to market with their at-home A1C test, Diabetic Investor was optimistic that Type 2 patients would have a useful tool in helping them manage their diabetes. Besides not having to take time from their busy schedules to go to their physician office to get the test, the results are easy to understand anything under 7 is good anything above 7 requires action. What could be simpler?
Still the International Federation of Clinical Chemistry (IFCC), the organization that establishes global clinical chemistry standards and procedures is seeking to take a simple and easy to understand test and make into something more complicated. Even worse along with the IFCC, the ADA, EASD and IDF are looking to have A1C test results reported in various ways:
1. 1. In percentages as it stands today
2. 2. with the current name and in units that reflect a new reference standard, i.e. as A1C in mmol/mol hemoglobin
3. 3. Use a new name and new units, i.e. as ADAG (A1C derived average glucose) in mg/dl or in mmol/lo dependent on the country
Diabetic Investor has seen some really dumb ideas in our time but this move is perhaps the dumbest of all. There’s an old saying when it comes to getting your point across with consumers Keep It Short and Simple or KISS. The IFCC, ADA, EASD and IDF should take this idea and KISS it goodbye.