The answer is, yes!  Some estimate that 40% of people with diabetes don’t know it; the percentage is higher for African-Americans.  Problem is, diabetes is a devastating disease.  Aggressive lifestyle management, medication (metformin), and weigh-loss surgery (bariatric, gastric bypass, banding, etc) may reduce or prevent progression to diabetes.

In the past diabetes was suspected if the fasting blood sugar was high.  The definitive test has been the oral glucose tolerance test, where a persons swallows a sugar load and has serial blood sugars measured soon thereafter.

The hemoglobinA1c (HgbA1c) gives an estimate of your average blood sugar level over the past 2-3 months.  It measures how much sugar sticks to the hemoglobin (oxygen-carrying protein) in your red blood cells.

This week, the New England Journal of Medicine published a study showing that an elevated HgbA1c predicts progression to diabetes, heart disease, and stroke.   They studied 11,092 black or white adults who did not have a history of diabetes or cardiovascular disease at baseline.

It does so better than baseline fasting glucose levels.

“In general, the reference range (that found in healthy persons), is about 4%–5.9%.^[16] Higher levels of HbA_1c are found in people with persistently elevated blood sugar, as in diabetes mellitus. While diabetic patient treatment goals vary, many include a target range of HbA_1c values. A diabetic person with good glucose control has a HbA_1c level that is close to or within the reference range. The International Diabetes Federation and American College of Endocrinology recommend HbA_1c values below 6.5%, while American Diabetes Association recommends that the HbA_1c be below 7.0% for most patients.^[17]”

In this week’s study, a HgbA1c > 6.0% was particularly ominous.

Take the American Diabetes Association test to see how likely you are to have diabetes.