HBA1c is often referred to as the 'Gold Standard' for diagnosis, but it not without its faults.
The problem is that what causes diabetes, is being diagnosed by glucose levels but, there are several reasons why you may have high glucose levels. In most cases, this doesn't matter too much because it is the high levels of glucose that you need to avoid.
You may have high levels because you don't produce enough insulin or because what you do produce is of poor quality. Or, after eating your insulin production may be slow to kick in. Or, you do produce enough of it but your muscle cells have become resistant.
The glucose in your blood does not easily bind to your red blood cells. That's what makes HBA1c a good diagnostic test. Because it is difficult, if your HBA1c is raised it pretty much means that you have high levels of glucose in your blood all the time. However, if you only have high blood glucose levels some of the time, your HBA1c may remain nearer the normal range. But, the high level of glucose in your blood plasma can still cause some diabetic complications. It's best to be safe on this.
I have taken the following from a paper entitled, The Pros and Cons of Diagnosing Diabetes With A1C
http://care.diabetesjournals.org/conten ... l.pdf+html
You don't have to understand them all but you will see that the difference between the various health professionals is one of interpretation of results. As far as I understand it, if it is showing up in your fasting blood plasma but not your HBA1c, it's probably going to be easier for you to control by watching what you eat and by taking some more exercise.
Reasons to prefer A1C compared with plasma glucose determination for diagnosing diabetes:
Chronic hyperglycemia is captured by A1C but not by FPG (even when repeated twice).
Microangiopathic complications (retinopathy) are associated with A1C as strongly as with FPG.
A1C is better related to cardiovascular disease than FPG.
Fasting is not needed for A1C assessment.
No acute perturbations (e.g., stress, diet, exercise, smoking) affect A1C.
A1C has a greater pre-analytical stability than blood glucose.
A1C has an analytical variability not inferior to blood glucose.
Standardization of A1C assay is not inferior to blood glucose assay.
Biological variability of A1C is lower than FPG and 2-h OGTT PG.
Individual susceptibility to protein glycation might be caught by A1C.
A1C can be used concomitantly for diagnosing and initiating diabetes monitoring.
Diabetes assessment with A1C assay is not necessarily greater than with glucose assessment.
Reasons not to prefer A1C compared with plasma glucose determination for diagnosing diabetes:
Diabetes is clinically defined by high blood glucose and not by glycation of proteins.
A1C is a poor marker of important pathophysiological abnormalities featuring diabetes.
A1C has a poor sensitivity in diabetes diagnosis and would change the epidemiology of diabetes.
2-h glucose level and IGT are stronger predictors of CVD than A1C.
Fasting is not essential to identify perturbation in glucose metabolism.
Standardization of A1C assay is poor, even in Western countries, and standardization of glucose
assay would be easier to implement.
In many subjects, A1C assay is unreliable and cannot be used.
A1C has significant differences in various ethnic groups, which are poorly understood and characterized.
Within-days biological variability of plasma glucose might unveil disturbance of glucose metabolism.
Individual susceptibility to glycation of hemoglobin is not relevant to diabetes diagnosis.
Using the same biomarker for diagnosing and monitoring diabetes might have negative effects.
Cost of the assay: glucose is unquestionably cheaper than A1C, and A1C assay is not available on a large scale in most of the countries.
A1C levels vary not only according to glycemia, but also to erythrocyte turnover rates (e.g., hemoglobinopathies, malaria, anemia, blood loss) as well as other factors.
Correlation between A1C and FPG is ~0.85%, which means that as many as 30% of the variation in FPG is not explained by A1C and vice versa.
Nothing is known about changes in A1C during the development of diabetes.
A1C levels of 6.0 - 6.5% do not predict diabetes as effectively as FPG and 2-h PG (OGTT).
Sensitivity of A1C to detect diabetes defined by the OGTT is, 50%; thus, the majority of diabetic individuals will remain undiagnosed if A1C is used.
The levels of A1C predicting future retinopathy, nephropathy, etc., in the population is not well established (6.5%?).
No diabetes prevention trials have selected their populations based on A1C.
Using A1C will delay the diagnosis of diabetes in ~60% of incident cases