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Question:

From Virginia Beach, Virginia, USA:

My 9 year old son was diagnosed with type 1 in December 2003. When we went to the pediatric endocrinologist for his three month check last week, I was surprised to find that they cannot test and give instant results for hemoglobin A1c right there in the office. I was under the impression, from this web site, that an instant result was the norm these days. Of note, this is at a teaching hospital/children's hospital in Norfolk, VA. We had to go down to the laboratory after the appointment for a venipuncture, which was traumatic for him. I would have liked to have avoided the venipuncture and would have liked to known the results right then so the visit would be more beneficial. I wonder if I could order a home test, which I have seen on this web site, and bring those results next time, instead of putting him through the trauma and not having results in hand for discussion. What do you think of those home tests?

Answer:

Personally, I have little experience with the home testing. There are potential pitfalls (expense, must mail off some of them so that results are "instant"; reliability has not been studied in the long term). The reliability of ANY lab test is very, very dependent upon the technique of the operator.

I agree that many pediatric endocrinologists will use some type of glycohemoglobin determination, such as A1c, that gives feedback within 10 minutes or so. Are they better than a venipuncture at the laboratory? Not necessarily. There are certainly data that indicate that diabetic patients who get immediate feedback so that insulin adjustments can be made "right then" do somewhat better than those patients who have to wait a week to get results mailed to them. But, please do not lose sight of the following: the glycohemoglobin value is only a part of the diabetic picture, an important part, to be sure, but only a part. The glycohemoglobin should support and complement any data one gets from home glucose monitoring with a glucose meter. If the values do no dovetail well, then one has to consider an irregularity, either in home monitoring or the glycohemoglobin determination.

Perhaps the clinic you attended only did not have an in-office glycohemoglobin determination just for that day? (Being upgraded or recalibrated?) I know that some hospitals have specific regulations and some offices must have specific waivers to allow in office glycohemoglobin determination.

Personally, I find it helpful, but not at all necessary, to have immediate turn around time for glycohemoglobin levels. As for the "trauma" yes, venipuncture is more invasive than a finger stick. If a child has hard to stick veins, it can be even more traumatic. Certainly, if one can avoid a degree of trauma, that might be reasonable. The child will likely undergo a true venipuncture about once a year anyway as other screening studies for diabetes-related health issues are screened for. Maybe it is best to minimize the emotional trauma and teach the child how to best prepare and deal with the reality?

DS

DTQ-20040405094329
Original posting 14 Apr 2004
Posted to A1c, Glycohemoglobin, HgbA1c

  
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Last Updated: Tuesday April 06, 2010 15:09:56
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