On Thu, 23 Feb 2006 13:36:02 -0600, OmManiPadmeOmelet
> wrote:

>In article >,
> Boron Elgar > wrote:
>
>> Insulin resistance shows up in fasting BGs, too, if they are tracked
>> over time or repeated if out of range.....and unless there are some
>> other risk factors involved, some indication of metabolic syndrome,
>> the HBA1c is an unusual test to order. There has to be some reason
>> for it. It is not part of a "normal" screen. It just isn't and I have
>> seen no guidelines that suggest it should be.
>
>It's a recent development. :-)

The increased usage is, but I'd like to see them get it past the
insurance companies without a diagnosis code to cover it.

>It's happening at our hospital, especially with docs that do a lot of
>weight loss work with their patients.

Docs doing a lot of weight loss work are dealing with a specialized
population.
>
>Granted, more docs still use it for tracking diabetic therapy, but we
>are seeing more and more of them ordered with people's annual lab work.

That is more likely do to the increase in diagnosed T2s and increase
in risk factors in the pop.
>
>When you only have 1 set of blood tests per year, the A1C is going to be
>far more indicative of an "average" daily blood glucose level than a
>random fasting BG.

But why do an expensive test without cause? Of course it is more
accurate than a random fasting BG, but spending money on unneeded
tests makes no sense. I think you'll find that there are reasons you
are running more HBA1cs, and that it is due to cause.

How fortuitous....

I just got off the phone with my GP, as I had lab work done on Monday
(pre-cert for minor surgery). I asked her about this and she told me
that she never orders it without some reason to do so and that a
annual physical in an otherwise healthy adult is not cause. It would
only be ordered for someone who is in a high risk category and being
watched or tracked (long term steroid use was one example she used) or
someone already diagnosed as diabetic.

Why not go talk to some of these docs who are ordering these tests in
your hospital and find out why they are ordering them?

Boron