The CDC has recently published a study in the American Journal of Preventive Medicine (April 2012) that used a “simulation model” in order to determine the glycosylated hemoglobin (HbA1c) level at which a diagnosis of prediabetes can be made. It states that lowering the cut-off of the HbA1c for an official diabetes diagnosis to 5.7% would be cost effective. Most Nutrientology readers know that the HbA1c reflects blood sugar levels over approximately the prior three months.
The American Diabetes Association currently recommends HbA1c testing for identifying diabetes and prediabetes with an HbA1c value of 6.5% as the diagnostic cutoff. In other words, levels over 6.5% are diabetic and 6.0% to 6.5% are prediabetic. This recommendation was made in 2009 and remains somewhat controversial. The ADA indicated 6.5% as the cutoff for true diabetes, but the level indicating prediabetes has variably been set anywhere from 6.0% to 6.5% by different professional groups. There is no clear threshold, that once exceeded, is associated with an accelerated risk of diabetes or other morbidities, but if your level is between 6.0 %-6.5 %, you need to be concerned and take action.
The National Institutes of Health website states that an HbA1c of 6% or less is normal, however they also then go on to say that less than 5.7% is “normal,” and prediabetes is 5.7%-6.4%. They have a cut-off of 6.5% or higher for an official diabetes diagnosis. Clearly not a black-and-white cutoff as illustrated by this discrepancy with both 5.7% and 6.0% being called normal (although only 0.3%).
CDC researchers took another look at the appropriate cut-off for prediabetes versus full-blown diabetes. They essentially did a cost-benefit analysis of lowering the cut-off to determine when early treatment for prediabetes would be cost-effective. (I suspect cost-benefit health care analyses such as this one will become more common in coming years.)
They determined that the cost of treating and managing patients with an HbA1c level less than 5.7% would likely outweigh any savings from addressing the increased blood sugar levels earlier and delaying, or preventing, full-blown type 2 diabetes.
Lower diagnostic cutoffs were not deemed beneficial because they didn’t produce a result that fell within the financial parameters set up in the cost-effective simulation model that was used.
The CDC authors concluded that lowering the HbA1c cut-off to 5.7
would be an efficient use of health care resources, although it might be necessary for all health insurers to participate to share prevention costs. Our results also indicate that although a prevention program would lead to cost savings in both younger and older people, it would achieve greater health and economic gains if it were directed at people under age sixty-five.”
Notice the last line? As health care resources become more difficult to pay for, we are going to see more of our health care being determined by actuaries and “simulation models.” One of the variables that will be plugged into the computer program running this cost-benefit analysis to make sure that health care resources are being used “efficiently” will be the age of the patient. How do you feel about that?