title: The metabolic deterioration that antedates diabetes: personal trajectories of HbA(1c)  and fasting glucose as early indicators and possible triggers for intervention.
abstract: HbA(1c) testing has become an accepted means of diagnosing diabetes as an alternative to blood glucose levels. However, population-based norms of glucose and of HbA(1c) levels do not enable the detection of diabetes at an early enough stage to thwart complications. Personal trajectories of glucose levels show steep increases a number of years prior to diabetes diagnosis. Here, we hypothesize that a comparable time-dependent deviation in an individual's HbA(1c) level may be an early manifestation of disease that should prompt lifestyle modifications. We predict that analysis of personal trajectories of glucose and of HbA(1c) will promote earlier intervention and a greater reduction in disease complications than current standards, which are based on population-based norms.
authors.affiliation: The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Israel. racheld@gertner.health.gov.il
authors.forename: Rachel
authors.initials: R
authors.lastname: Dankner
authors.forename: Michael
authors.initials: M
authors.lastname: Bergman
authors.forename: Ann
authors.initials: A
authors.lastname: Danoff
authors.forename: Sana
authors.initials: S
authors.lastname: Qureshi
authors.forename: Ian
authors.initials: I
authors.lastname: Whitford
authors.forename: Nargess
authors.initials: N
authors.lastname: Kaviani
authors.forename: Yevgeniya
authors.initials: Y
authors.lastname: Dynkevich
authors.forename: Jesse
authors.initials: J
authors.lastname: Roth
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000378:metabolism; D042241:Early Diagnosis; D005215:Fasting / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism; D011236:Prediabetic State / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human