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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAverage blood glucose may accurately reflect a patient\u0027s daily variations in blood glucose, and may be a number that is easier for patients to understand than HbA1C. These findings from an international study support the recent agreement among diabetes organizations worldwide to standardize how HbA1C test results are reported.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ehyperglycemia\/hypoglycemia\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EStandardizing the Reporting of HbA1cTest Results\u003C\/h2\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1755754571\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11280\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EAverage blood glucose may accurately reflect a patient\u0027s daily variations in blood glucose, and may be a number that is easier for patients to understand than HbA1c. These findings from an international study support the recent agreement among diabetes organizations worldwide to standardize how HbA1c test results are reported.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe new approach uses a reference method proposed by the International Federation of Clinical Chemistry (IFCC) that measures a single molecular species of glycated HbA1c and is reported in units of mmol\/L (or mg\/dL) instead of the widely used National Glycohemoglobin Standardization Program (NGSP) method, which gives a percentage value derived from a mixture of glycated hemoglobin.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe IFCC reference number can be translated into the familiar DCCT HbA1c values using simple mathematic formulas, and also into the more patient-friendly average blood glucose number. The adoption of this new approach significantly changes the numerical results provided to clinicians. HbA1c results will be reported worldwide in both IFCC units (mmol\/mol) and derived NGSP units (%). For example, an HbA1c value of 5% would become \u223c33 mmol\/mol, and 8% would be \u223c65 mmol\/mol.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe statement was issued in August by the European Association for the Study of Diabetes, (EASD), the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and called for a new standard for measuring and reporting glycosylated hemoglobin. At a press conference, speakers emphasized the need for an internationally recognized reference measurement system (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Consensus on the Worldwide Standardization of the A1c Assay.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1755754571\u0022 data-figure-caption=\u0022Consensus on the Worldwide Standardization of the A1c Assay.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/6\/4\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11282\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EConsensus on the Worldwide Standardization of the A1c Assay.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EDifferent test results from different systems lead to high costs and poor medical reliability, they noted. When universally comparable test results are used instead, there are lower costs and increased clinical reliability. In the case of diabetes, there is a clear need for consistency between the daily self-monitoring of blood glucose and the HbA1c values that clinicians use to monitor and manage chronic glycemia, they said.\u003C\/p\u003E\n         \u003Cdiv id=\u0022sec-2\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EADAG Results Reported\u003C\/h3\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EJudith C. Kuenen, MD, VU University Medical Center, the Netherlands, presented the results of the international HbA1c-Derived Average Glucose (ADAG) study, which showed that an estimated average glucose obtained by repeated measurements over 3 months, correlates very closely with HbA1c at the end of those 3 months. The findings support the use of this new method for reporting chronic glycemia. \u201cI hope this is what you remember from your stay in Amsterdam,\u201d said JC Kuenen.\u003C\/p\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EThe objective of the ADAG study, which was conducted at 10 centers in Europe, North America, and Africa, was to establish the relationship between average blood glucose concentrations and HbA1c values according to the DCCT method in patients with type 1 and type 2 diabetes. This relationship would be used to predict average blood glucose from a measurement of HbA1c in a standardized manner. The study included 643 patients; 323 with type 1 diabetes, 230 with type 2 diabetes, and 90 non-diabetic volunteers. HbA1c levels were measured in a central laboratory using the DCCT standard monthly for 4 months. Glucose values were obtained using a combination of continuous glucose monitoring for 2\u20133 days for each of the 4 months, plus frequent fingerstick glucose measurements.\u003C\/p\u003E\n            \u003Cp id=\u0022p-10\u0022\u003EJC Kuenen presented the results for the first 427 patients. In a regression analysis, average blood glucose over 3 months compared well with HbA1c at the end of Month 3. The standard deviation of the error was only 0.83 mmol\/L, indicating a strong correlation between average blood glucose and HbA1c.\u003C\/p\u003E\n            \u003Cp id=\u0022p-11\u0022\u003E\u201cNot surprisingly, the size of the error increases with higher HbA1c values, however, over the entire HbA1c range, \u0026gt;90% of the values fell within \u00b115,\u201d she added.\u003C\/p\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EUnder the previous NGSP assay and nomenclature, the ADA\u0027s recommended target was an HbA1c of \u0026lt;7%, and ideally \u0026lt;6%. Using the preliminary results of the proposed equation between mean blood glucose and HbA1c, a HbA1C of 7% would be converted to an estimated average blood glucose of 8.6 mmol\/L (155 mg\/dL).\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-3\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EWhat\u0027s Ahead\u003C\/h3\u003E\n            \u003Cp id=\u0022p-13\u0022\u003ERobert Heine, MD, also from VU University Medical Center, emphasized that the findings of the ADAG trial fully support the new recommendations for standardized HbA1c reporting. The consensus statement had anticipated favorable findings from ADAG and had tentatively recommended that average glucose be one of the three ways by which chronic glycemia is reported.\u003C\/p\u003E\n            \u003Cp id=\u0022p-14\u0022\u003E\u201cThese results are better than we expected and could have hoped for,\u201d Prof. Heine commented. \u201cLuckily, there is consensus among the diabetes associations to apply this as the global reference standard. All of the major diabetes organizations are on board.\u201d\u003C\/p\u003E\n            \u003Cp id=\u0022p-15\u0022\u003EPatient lab results, as well as the units reported in clinical trials, will therefore be reported in all three ways, giving physicians some degree of choice in how they discuss test results with patients. The transition will not happen overnight, Prof. Heine noted. \u201cGetting used to new numbers requires 2 to 3 years,\u201d he said.\u003C\/p\u003E\n            \u003Cp id=\u0022p-16\u0022\u003EAt the press conference, representatives from the various diabetes associations emphasized that the HbA1c test itself will not change. Rather, different algorithms will be used to determine test results, and results may be communicated differently to patients. The new method may make more sense to patients, who are accustomed to seeing the results of their self-monitoring of blood glucose expressed in mmol\/L or mg\/dL, not percentages, said the Executive Director of the ADA, Richard Kahn, MD.\u003C\/p\u003E\n            \u003Cp id=\u0022p-17\u0022\u003E\u201cThe diabetes organizations would encourage physicians to use average glucose, but some might decide to use the older methods,\u201d he said. However, the hope is that over time the estimated average glucose will eventually become the gold standard for chronic glycemia targets and reporting.\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/6\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm7op\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm7op\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}