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Diabetes guidelines released recently by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) in Jacksonville, FL, call for more aggressive treatment and earlier screening. The guidelines say diabetes screening should begin at age 30 in high-risk groups, whereas current standards call for screening to begin at 45. The federal Centers for Disease Control and Prevention reports that the prevalence of diabetes has increased 76% among those ages 30 to 39.
In addition, the guidelines lower the target on the glycosylated hemoglobin A (HbA1c) test to 6.5% from the previously recommended 8%. The ACE/AACE consensus panel recommends that the HbA1c test be universally adopted as the primary method of assessment of glycemic control. The panel says it should be performed at least twice a year in patients whose levels are on target and more often in patients whose levels are above target and in those who are changing therapies.
Claresa Levetan, MD, director of diabetes education at Medstar Clinical Research Center in Washington, DC, and a member of the panel, explains that the HbA1c test should be called simply the A1C test. "It is critical that patients know their A1C level and their goals," she says.
The guidelines also set targets for plasma glucose: Fasting and preprandial levels should be <110 mg/dL and two-hour postprandial levels should be <140 mg/dL.