Why One Diabetes Diagnostic Test Isn't Enough
Prevention & Treatment Diabetes is an illness that involves constant change in glucose levels. As a result, having multiple diagnostic tests is not just a good idea, but a necessity.
The key to managing diabetes lies not just within lifestyle changes and medication, but also in understanding the unique characteristics of each diagnosis.
Diabetes occurs when blood glucose (sugar) levels rise higher than normal, according to the American Diabetes Association (ADA). When the pancreas is not working properly, it's not producing insulin and as a result, the glucose levels remain high. Some patients experience glucose variability, yet most diagnostic tests do not capture these severe peaks and drops–making it crucial to perform multiple diagnostic tests that provide a full picture to help improve management of the disease.
The traditional standard
A1C is considered the standard diabetes test according to Endocrinologist Dr. Michael H. Shanik. The A1C test “represents a two to three month average of blood sugar readings.” However, this is where the test falls short. “Certain patients might have an average that's in a good range, but they might also have fluctuations where the blood sugar is very high or low at times — A1C is based on the lifespan of the red blood cells in the body, so either increased or decreased cells could falsely lower or raise the A1C,” according to Dr. Shanik.
“There’s value to each diagnostic test and all are vital to managing and controlling diabetes.”
Additionally, there are a number of conditions and medications that can affect A1C test results. Gary Scheiner, MS, CDE advises, “A1C can be influenced by several factors, including hemoglobinopathies, anemia, hemolysis, recent blood donations/transfusions.” For example, “A1C tends to run slightly higher in older patients, lower during pregnancy, and there is also some evidence that ethnic minorities have slight elevations in A1C without actual increases in blood sugar levels.”
With average glucose level-focused tests, glucose peaks can be hidden in the number that represents the patient’s glucose control. There are additional tests that can help provide better perspective.
GlycoMark is an important test that evaluates “short-term control and helps evaluate glycemic variability. It becomes abnormal when glucose levels go higher than what's called the renal threshold,” says Dr. Jeff Dahlen, Director of Scientific Affairs at GlycoMark.
Finger prick tests provide a snapshot of glucose levels at a particular moment, which can tell how high or low levels are varying only when timed correctly.
As advised by Scheiner, “The ADA publishes standards of care that are updated regularly. This includes not only diagnostic criteria and recommendations for self-monitoring, but also a battery of recommended laboratory tests/procedures to guard against diabetic complications.”
There’s value to each diagnostic test and all are vital to managing and controlling diabetes. The most complete information is obtained when tests are used in tandem with others.