![]() ![]() In the US, HbA1c values are reported as percentages using the National Glycohemoglobin Standardization Program (NGSP) scale. Hazard ratios (HRs) were derived from Cox proportional hazards models for survival time outcomes (Cox survival models), with adjustments for age, sex, smoker status, blood pressure, cholesterol, body-mass index (BMI) and disease history.īefore we review the current literature, let’s recap the different ways in which HbA1c is measured and how the measurement can be used to diagnose diabetes. ![]() During a total of 671,232 person-years of follow-up (range: < 1 year to 27 years average 11 years), 11,569 deaths were recorded. Of these, 5,840 (10%) said they had previously been told by doctors they had diabetes at baseline. The analysis covered 59,424 individuals spanning the ages of 18 to 89. Our analysis assessed the relationship between HbA1c and all-cause mortality using data from the Centers for Disease Control and Prevention’s (CDC) National Health and Nutritional Examination Surveys (NHANES 1988-2015). Studies published since 2007 have added greatly to our understanding of the importance of HbA1c levels, particularly for people without diabetes. In recent years, substantial research effort has been devoted to determining the relationship of HbA1c with all-cause mortality. (It should be noted that the study was unable to make a distinction between diagnosed and undiagnosed diabetes and mortality results, therefore, included people with diabetes.) Interestingly, the study also reported increased mortality for those with HbA1c values below 5%. 1 The study, which examined mortality among 286,443 non-smoking US insurance applicants, found even small elevations of HbA1c above 5.9% can be associated with significant levels of excess mortality. Then, an important 2007 study reported the existence of a relationship of HbA1c and 5-year all-cause mortality. It was primarily used as a reflex test for applicants with raised fructosamine levels, evidence of urinary glucose, hyperglycemia or a history of diabetes. life insurers through the 1990s, and HbA1c was gradually added to the underwriter’s armory. Laboratory tests for applicant assessment were increasingly used by U.S. The HbA1c test has an advantage over traditional glucose testing as fasting is not required and the results are not subject to day-to-day fluctuations. Unlike blood glucose testing, which simply measures the concentration of glucose in the blood when the test is administered, the HbA1c metric reflects average blood glucose levels during the last 2 to 3 months. ![]() Since then, the HbA1c test has become the gold standard for monitoring glycemic control in people with diabetes. The A1c component of hemoglobin and its relationship with diabetes was first discovered in the late 1960s, and using it as a diagnostic test for diabetes came into clinical practice during the 1970s and 1980s. With HbA1c testing on the rise, an increasing number of underwriters are starting to look more closely at the mortality implications of its results. More recently, underwriters have begun looking at whether HbA1c test results could also be used to refine mortality risk assessment for people with pre-diabetes and even to fine-tune mortality risk assessment for people in good health. The test, which measures how much hemoglobin in the blood is bound to glucose over time, is also used to detect non-disclosure of diabetes or undiagnosed diabetes. Tab will move on to the next part of the site rather than go through menu items.įor many years, underwriters have used HbA1c tests to assess blood sugar control in people with an established diagnosis of diabetes. Enter and space open menus and escape closes them as well. Up and Down arrows will open main level menus and toggle through sub tier links. Left and right arrows move across top level links and expand / close menus in sub levels. The site navigation utilizes arrow, enter, escape, and space bar key commands. ![]()
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