In article >,
Boron Elgar > wrote:

> 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.

Docs are going to be skilled at coding...
Obesity is rampant in the US and puts one at higher risk for Type II.
IMHO that seems to justify 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.

Yah. About 60% of the US 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.

I see you just made my point, thanks!

> >
> >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.

I see your point there, but again it has to do with the fact that adult
onset type II can come on rather quickly and cause a lot of damage
before you pick it up. The cost for that test at our hospital, including
the venipuncture and administrative fees is $75.00.

A standard profile runs more than that and if it's only annual, well,
let's just say it's not a bad idea!

Indications? If you feel you are at risk for whatever reason, I'd say
that's indication enough?

>
> 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?

I've only talked to my own doc. She orders them as an annual test on all
of her patients because she feels it is far more accurate.....

>
> Boron
--
Peace, Om.

"My mother never saw the irony in calling me a son-of-a-bitch." -Jack Nicholson