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Statistics show that the percentage of new-onset type 2 diabetes cases in adolescents has risen significantly. The diagnosis of diabetes, as well as evaluation of the type and severity, are critical to the proper management of treatment to prevent the onset or progression of serious complications.
The two most prevalent diagnostic tests used today are the fasting plasma glucose (FPG or “glucose”) test and the hemoglobin A1c (HbA1c) test. FPG testing measures short-term glucose metabolism—blood sugar levels at a given point in time. FPG is inexpensive and globally available, and it is a standard part of a routine blood panel.
HbA1c is not impacted by fasting, stress, or exercise and it can be done with a sample taken at any time (non-fasting). Both FPG and HbA1c tests are important in patient diagnosis and management of diabetes, and both should be performed in initial evaluation when a physician suspects that a patient has a high risk of diabetes. The American Diabetes Association (ADA), the Endocrine Society, and the World Health Organization (WHO) have all endorsed the use of HbA1c in the screening and diagnosis of diabetes. Despite the widespread medical and scientific acceptance of the validity of HbA1c, it is not a replacement for FPG.
Jack Zakowski, PhD, FACB, serves as Director of Scientific Affairs for Beckman Coulter Diagnostics.
There have been a few times where she's caught me off-guard, because it turns out she was actually listening as I babbled on about All Things Diabetes. Earlier this week, she told me that she had been talking with - well, I actually can't remember now.
Years ago, when I had so little knowledge of what type 2 diabetes actually was (and I'm still very much learning, btw), I can assure you I would have agreed with her. The diabetes online community, and the storytellers within it who share their lives with type 2 diabetes, have helped me understand the other 95%. When you look at the true definition of "worse", it's not as easy to attribute that word to one side or the other. Just a decade ago, type 2 diabetes in adolescents constituted less than three percent of new adolescent cases, globally.


Children with diabetes often died within weeks; adults with type 2 diabetes were fortunate to live 10 years after diagnosis, and many died much sooner. The definitions of what constitutes diabetes are more laboratory-based than ever before; as the incidence of disease continues to grow, symptoms alone (such as excessive thirst or frequent need to urinate) are not definitive, and diagnosing and treating the disease in its earliest stages can dramatically lower a patient’s risk of developing more advanced diabetes and its attendant complications. Debates have been ongoing for some time about which test is best for an accurate diagnosis of diabetes and ongoing diabetes monitoring. Fasting for at least eight hours prior to testing is critical, as baseline glucose, not postprandial, needs to be measured. Glucose in the serum reacts with an amino acid group on hemoglobin to form glycated hemoglobin. Because FPG measures short-term glucose metabolism, it works well for management of acute episodes; and because it is inexpensive, it is the most appropriate first test to indicate the potential presence or future risk of diabetes. For example, a patient who is obese and who experiences frequent urination, excessive thirst, and blurred vision or headaches, should undergo FPG and HbA1c testing to determine if diabetes is present.
In the ADA’s 2010-2013 Standards of Medical Care in Diabetes,4 HbA1c testing is recommended twice yearly in diabetes patients who are stable and meeting treatment goals, and quarterly for diabetes patients who need closer monitoring. Both tests have pros and cons to their use, and both tests provide physicians and patients with critical information—either regarding short-term or long-term glucose concentrations—that can help patients to delay or avoid serious complications. She knows I have type 1 diabetes, and though I've tried to explain the gist of what that means (and why it's different than "the diabetes two" that her uncle has), I can always feel that she's still not quite certain. With the introduction of insulin to treat diabetes in 1922, individuals with diabetes were able to live longer and more productive lives.
With type 2 diabetes mellitus, the body produces insulin but, over time, cells in the body no longer respond properly to it.
Hemoglobin A1c is defined as that product of reaction of glucose with the N-terminal amino acid of the hemoglobin beta chain. However, as noted above, the fasting component of the test is crucial—and sometimes problematic. HbA1c values are generated using an assay standardized to an international reference material that gives a clear picture of the body’s average glucose over time. However, it is more expensive than FPG, so it may not be as readily available in less developed or affluent parts of the world.
Once a diagnosis has been made, FPG or, in some cases, non-fasting glucose plasma is the most appropriate test for diabetic treatment episodes, giving physicians and patients quick results regarding the current blood glucose state.


Non-diabetics with high risk factors for diabetes (overweight, lack of exercise, hypertension, family history of diabetes, etc.) or who are over age 45 can all benefit from HbA1c testing, repeated at three-year intervals if normal.
National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014.
I continue to learn that diabetes, in any form, is a hard-fought battle with odds that are rarely in one's favor. However, especially when not controlled properly, complications from diabetes continue to cause blindness, kidney failure, non-traumatic lower limb amputation, shock, coma, and death.
The pancreas may continue to make insulin for some time, or may eventually stop production altogether. It is important to understand what each type of test measures and how to properly employ each test to help diabetes patient management. A patient may say he or she has fasted for eight hours, but mean “except for the sugar I put into my tea and one slice of dry toast so I could take my medicines this morning.” In addition, factors such as stress, exercise, and acute illness can impact readings on any given day.
In addition, HbA1c results can be affected by an altered lifespan of erythrocytes and by the presence of hemoglobin variants. She understands when I have to turn down the offer of going for a smoothie mid-afternoon, or when I decide to stay at my desk instead of going for a quick walk. Clearly, the laboratory’s role in helping physicians and patients diagnose and manage diabetes has never been more critical. Type 2 can appear in young, healthy, athletic adults and children - and it isn't always someone's fault. In addition, conditions that decrease average erythrocyte lifespan can cause apparentincreases in HbA1c levels. She knows about my second life as a diabetes advocate, and where I'm going when I take a few days off of work.



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