For at least three consecutive years now at the annual ADA Conference, we keep hearing about a rumored switchover from the A1c as the gold standard average glucose measurement. Instead, we'll get something new and supposedly easier to understand: a new measure that more closely reflects the mg/dL (and international mmol/l) numbers we all get on our home glucose meters. This new test is now dubbed the eAG (estimated average glucose).
One of the big news announcements Scientific Sessions this week was the results of a large international study that supposedly underscores the accuracy of the eAG. In this 10-center study, 507 volunteers with diabetes had their A1c translated into eAG readings and compared with their running daily BG results, if I understood the press materials correctly. "Study investigators found a simple linear relationship," the ADA press release states.
Also stated: "Patients find it difficult to relate the A1c's percentage of hemoglobin that is glycated (and a goal of under 7%) to the self-monitoring of blood glucose they do at home... To reduce confusion, researchers have conducted a major international study to demonstrate how A1c correlates with self-monitoring."
The ADA is clearly pushing hard for a massive migration to the eAG, which I find incredibly odd. They've even created little red handheld calculators (shown here) that they plan to sell to physicians off their website for easier conversion of A1c values into the "simpler" eAG. You can try their online calculator HERE.
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One reason I find this so odd is that just last September, the Diabetes Care Coalition, a consortium backed by the ADA, JDRF and AADE, along with a half-dozen major pharma companies, launched a sweeping "Know Your A1C" public service campaign to get people aware of their A1c and what to do about it. I have to assume they're just gaining traction with that campaign, so why "reinvent the wheel" by throwing an entirely new measure at an already struggling-to-understand audience?
When you dig a little deeper, you discover that the whole eAG initiative is less about reducing patient confusion and more about a good, old-fashioned standards war between competing associations and scientific factions, with the ADA on one side and the International Federation of Clinical Chemistry (IFCC) on the other — and PWDs caught in the middle.
It seems the IFCC was on its way to creating yet another average glucose measurement that the ADA disapproved of even more, so the organization is preempting that move by jumping on the eAG bandwagon. So much was acknowledged in a press briefing at the conference this weekend.
So whose standards will prevail? And where do we patients stand?
Of course it's clear to me that far too many patients in this country don't understand the A1c measurement (which btw is an average measured as a percentage of the amount of sugar attached to your hemoglobin molecules, which are present in your red blood cells). But I'd venture to state that the problem isn't that the A1c result is expressed as a percentage, rather than a number that matches your home glucose meter (which lots of people don't use or understand either).
The problem is that too many patients out there don't even know there is such a thing as a three-month average glucose measurement or what it means to their health. THAT, my friends, is what matters. Why confuse the heck out folks by abandoning a measure that the D-world has known it for 25 years? In addition, so much effort has recently been made to promote the A1c, why kill it now? A nationwide switchover would no doubt be a very costly enterprise.
On top of all that, let's look at the facts. We Americans do tend to cling to our traditional measurements, no matter how unclear they may seem. Come on, have we switched over to the metric system yet? Who cares that it's much more logical and intuitive than feet and pints and ounces?