HbA1c May be Superior to FPG in Diagnosing Prediabetes

FPG (fasting plasma glucose), HbA1c, and the OGTT (oral glucose tolerance test) are used in determining if someone has prediabetes or diabetes. Indeed, all three measures are employed by the National Diabetes Prevention Program (National DPP) to determine eligibility for the National DPP. So, these blood based tests are important, and understanding which one of the three measurements is the most valid in assessing prediabetes and diabetes is a worthwhile undertaking. One recent study has focused on determining the validity of the measurements.

The OGTT is considered by some to be the gold standard for diagnosing diabetes and prediabetes. However, it is not always practical to perform the test, and results are not always reproducible. Therefore, while the OGTT is considered to be more accurate for some high risk patients than the HbA1c test, the HbA1c test is widely used since it is more practical and it is considered to be a valid test. So, determining how the test stacks up against the FPG test is high on the priority list.

In the above mentioned study, 201 patients were looked at. And the investigators concluded that “HbA1c is a more sensitive test compared to FPG in the diagnosis of DM. Prospective studies with broad participation at national and international levels are needed to redefine HbA1c cut-off points for the diagnosis of DM and prediabetes." When this is done, "it will be possible to revise the diagnostic guidelines accordingly.”

While work needs to be done in the area of defining the cut-off points for HbA1c to improve the diagnostic value of the measurement, the above study does seem to indicate that engaging in additional research to define the Hba1c cut-off points is worth the effort.

Healthcare providers should pay attention to this study and other studies related to diabetes and prediabetes measurements. If we can increase the validity of the measurements already in place, this will lead to improved assessment of prediabetes and diabetes. This endeavor will help providers deliver more accurate assessments to patients, enabling patients to take the appropriate actions.

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The Green Mediterranean Diet

During the 1960s, countries such as Italy and Greece followed the diet that has become known as the Mediterranean diet. And people in Mediterranean countries that followed the diet were very healthy compared to Americans who follow common American diets. The Mediterranean diet has been found to improve health and lower premature death. Further, a recent study found that a modified version of the diet, called the green Mediterranean diet, may be healthier.

The Mediterranean diet consists mostly of fruits, vegetables, whole foods, and a moderate amount of meat products, including cheese, poultry and eggs. There is also very infrequent use of red meat, and no use of sugar sweetened beverages or processed foods.

The green Mediterranean diet is not substantially different from the original Mediterranean diet. It essentially replaces the red meat with plant protein, and reduces the amount of all animal protein. A person replaces the animal protein with things like quinoa, soy milk and other sources of protein.

In the study mentioned above, participants were assigned to three groups. One of the groups was the healthy diet guidance (HDG) group; another group was the Mediterranean diet group, and the other group was the green Mediterranean diet group. In the study, all three of the diets were combined with physical activity. After six months, participants in the Mediterranean and the green Mediterranean diet groups had similar weight loss.

However, participants in the green Mediterranean group had greater improvement in the cholesterol, diastolic blood pressure, insulin resistance, and other metabolic parameters. The researchers concluded that “the green MED diet, supplemented with walnuts, green tea and Mankai and lower [helpings of meat and poultry] may amplify the beneficial cardio metabolic effects of Mediterranean diet.”

It appears that while the Mediterranean diet is a very healthy diet, the green Mediterranean diet, which is more plant-based with increased intake of plants that are heavy in protein, may be even healthier. Healthcare providers should consider the green Mediterranean diet when counseling patients.

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