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Old 01-27-2011, 06:21 AM   #21
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Hmmm, I see some confusion here, at least regarding health care economics. Recall that obese people, smokers, and especially obese smokers use less lifetime health care than healthy people.

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Then factor into the equation that they won't put a strain on SS payout.

Cheers!
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Old 01-27-2011, 07:08 AM   #22
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Practically, it is not often a problem since HgbA1C is not interpreted like a blood sugar, but rather as a long term barometer of control.
Not sure exactly what you mean by this. Lower A1c seems to be correlated with fewer diabetes-related complications. But isn't this just another way of saying that, for diabetics, the lower the average blood glucose the better? As I understand it, the only way to estimate the average blood glucose (EAG) practically and economically is to measure A1c. There is even a formula that relates EAG to A1c. The ADA is recommending using this formula to do the conversion and reporting the EAG to patients instead of the A1c

Estimating Average Blood Glucose
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Old 01-27-2011, 08:41 AM   #23
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Not sure exactly what you mean by this.
Marked glucose volatility may be overlooked if you rely solely on the HgbA1C. That is one reason why you look at home blood glucose readings, symptoms, and other factors as well. And occasionally patients may not be forthcoming about poor control at home, then behave themselves a few days before their doctor visits. The glycohemoglobin may be a useful tipoff and lead to beneficial discussions.

I imagine that average blood sugar, taken at strictly controlled times and firmly structured insulin or medication use would be useful, but much more cumbersome. Plus the outcome studies are much more robust with hgbA1C. But yes, EAG and HgbA1c could reasonably be considered as proxies for one another under the right circumstances.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 01-27-2011, 09:32 AM   #24
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Marked glucose volatility may be overlooked if you rely solely on the HgbA1C. That is one reason why you look at home blood glucose readings, symptoms, and other factors as well. And occasionally patients may not be forthcoming about poor control at home, then behave themselves a few days before their doctor visits. The glycohemoglobin may be a useful tipoff and lead to beneficial discussions.

I imagine that average blood sugar, taken at strictly controlled times and firmly structured insulin or medication use would be useful, but much more cumbersome. Plus the outcome studies are much more robust with hgbA1C. But yes, EAG and HgbA1c could reasonably be considered as proxies for one another under the right circumstances.
I think you are missing my point (or more likely, I am making it poorly).

The ADA is recommending that patients still have their A1c checked bi-annually, but that the results be converted to EAG with the formula cited in my link, with the hope that the EAG will indicate to the patients that perhaps the average number they are getting from their home meters is artificially biased low due to infrequent testing (e.g. once a day) and also testing at times which are more convenient (e.g. before meals as opposed to after).

As I understand it, in the study to come up with a formula relating A1c to EAG, the subjects wore 24-hour meters that took readings at regular intervals (e.g. every X minutes). They then regressed the average of these data aginst the A1c measurements to come up with the formula cited in my link.

Thus, the only real difference is that the same results will be reported to the patient as a different number. I would guess many doctors have (or should have) tables like the one cited in my link so, that they can tell their patients what the A1c number means in terms of average blood sugar level.

Finally, IMO, the upside of this is that maybe doctors, patients, and even the ADA itself will recognize that an A1c of 7% (EAG = 154) is really pretty lousy blood glucose control. Think about what range of blood glucose values would likely lead to an average of 154. Someone whose blood sugar averaged 154 is probably experiencing dangerous levels of blood sugar much of the time.
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Old 01-28-2011, 05:07 PM   #25
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Interesting.
I was obese for several years (40s & 50s) and did not develop diabetes.
Mother did develop diabetes (insulin dependent) in her 50s.
I wonder if it was because I got fat on fat and meat and not on sugar.
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Old 01-28-2011, 07:45 PM   #26
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Finally, IMO, the upside of this is that maybe doctors, patients, and even the ADA itself will recognize that an A1c of 7% (EAG = 154) is really pretty lousy blood glucose control. Think about what range of blood glucose values would likely lead to an average of 154. Someone whose blood sugar averaged 154 is probably experiencing dangerous levels of blood sugar much of the time.
Plus, there are other issues that can influence A1c numbers. I'm not positive what the cause is, but I've never scored higher than 5.9 on an A1c, but I've also never registered under 100 on a regular meter check. Usually closer to 150, and often fasting is over 200. This is all without medication. And I'm actually pretty consistant BGL wise. Not good, but consistant. So something is causing me to register normal on the A1c, even though I'm definitely diabetic. My personal guess is that my slight anemia is the cause, but my doc and endo don't have an explanation. So it is very important (assuming yoy are diabetic or even pre) to do the at home testing. A1cs can be misleading.
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Old 01-28-2011, 08:02 PM   #27
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The dirty little secret the medical community is keeping from you is that more than nine out of ten North Americans currently suffer from senescence.

Don't just sit there; call your Congresscritter right now and demand that something be done about this scourge.
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Hmmm, I see some confusion here, at least regarding health care economics. Recall that obese people, smokers, and especially obese smokers use less lifetime health care than healthy people.
Didn't we have recently a long thread on SS funding running out?

Heck, I say we call Congresscritters to ask them to incentivize people by providing earlier and/or higher SS to people who smoke and have high BMIs. Remember that Medicare is a bigger drain to the country coffer than SS. Better give 'em more SS earlier than lots of Medicare later. It would be a good exchange, I believe.

We cannot afford too many Jack Lalannes. Oops! I forgot that Jack Lalanne types can be put to w*rk until their 90s.
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