Diabetes Self-Management Blog

For years, it has been probably the most memorable number for people with diabetes: Seven percent or lower, according to the American Diabetes Association, should be the target HbA1c level (a measure of long-term blood glucose control) for most people. In its Standards of Medical Care in Diabetes — 2010, the Association notes that reaching an even lower HbA1c level has been associated with further benefits, namely a lower risk of small-blood-vessel diabetic complications such as neuropathy (nerve damage), nephropathy (kidney disease), and retinopathy (eye disease). But it also warns that the risk of hypoglycemia may outweigh the benefits of reaching an HbA1c level below 7%.

Now, the authors of a study published in the journal The Lancet suggest that even 7% may be too low as a general HbA1c goal for people with Type 2 diabetes. To reach this conclusion, the researchers examined a database of nearly 48,000 people with Type 2 diabetes, ages 50 and over, who took either multiple oral medicines or insulin (or both) for their diabetes. Based on these participants’ average HbA1c levels, the researchers created 10 equal-size groups for analysis. When they examined the rate of death in these groups after controlling for age, sex, smoking status, cholesterol levels, cardiovascular risk, and general illness, they found that a lower HbA1c level was not consistently associated with a lower risk of death. In fact, the group with the lowest HbA1c level — an average of 6.4% — had a risk of death 1.52 times as high as the lowest-death-risk group, whose average HbA1c level was 7.5%. The group with the highest HbA1c level — an average of 10.5% — did also have the highest risk of death, 1.79 times that of the lowest-risk group.

According to a summary of the study on the Web site Aetna InteliHealth, these findings add to concerns about lowering HbA1c too much that were raised by the 2008 ACCORD study. Researchers ended ACCORD’s intensive-blood-glucose-control study arm 17 months early when they found that participants were dying at a rate 22% higher than in the standard-blood-glucose-control group. The researchers offered several possible reasons for the higher rate of death in the intensive-control group, including rapid lowering of blood glucose levels, a heavier weight and greater weight gain than in the standard-control group, side effects of the drugs used to lower blood glucose levels, and a greater likelihood of hypoglycemia in this group.

An important difference between ACCORD and the Lancet study, however, is that the new study did not randomly assign participants to a treatment group as ACCORD did; it just looked at what HbA1c levels they had achieved, without knowing what they were trying to achieve. This means that external factors could have affected the results — for example, people who were already prone to hypoglycemia (either naturally or because of specific diabetes treatments) could have had lower HbA1c levels because of their hypoglycemia. In this case, the higher risk of death associated with lower HbA1c might be the result of a hypoglycemia tendency that most people don’t have, so broadly recommending higher HbA1c levels would not make sense. Even in the case of ACCORD, many people argued that the drug treatments used in the study — rather than a lower HbA1c in general — could have caused the higher risk of death in the intensive-control group. And, in fact, a study released soon after ACCORD that used different drug treatments but followed a similar design (ADVANCE) found “no indication of harm” from the lower HbA1c level achieved in its intensive-control group.

What do you think — did the Lancet study authors jump the gun by writing that HbA1c guidelines should possibly be reevaluated? Should more effort go toward investigating the safety of treatments used in studies, such as ACCORD, that find a higher risk of death associated with intensive blood glucose control? Should studies put a greater emphasis on how a lower HbA1c level is reached, rather than just on that number? Have you or your doctor made any changes to your diabetes treatment as a result of any of these studies? Leave a comment below!

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Comments
  1. This is so confusing. Are they basically saying that it is safer to keep your blood sugars relatively stable, even if they are running a bit high versus having wide swings?? Am I understanding this correctly? There is just so much conflicting information out there. I don’t know if I am doing the best thing for myself or not.

    Posted by susie |
  2. No one ever agrees on what the correct A1C is! I am a type 1 with an A1C of 4.5. I work hard to get that number. Why isnt this article for type 1 as well? Give it a year or two and those numbers they state will change - it always does!

    Posted by GiGi |
  3. The U.K. researchers reviewed records of diabetics treated either with 1) two oral medications (usually metformin and a sulfonylurea), or 2) a regimen containing insulin. Each group had over 20,000 subjects. They found that risk of death for those with an average HgbA1c of 6.4% (the lowest blood sugar levels in this study) was 52% higher than those with HgbA1c of 7.5%. Those with the highest blood sugar levels over time—HgbA1c over 10% if I recall correctly—had the highest risk of death. In general, those taking insulin had higher rates of death than those on pills.

    It’s extremely difficult to interpret studies like this. There are myriad ways to treat diabetes. We have 10 classes of drugs for treatment of diabetes: this study looked at three. There are at least three types of “diabetic diet” in common use: low-fat/high-carb, low-carb, and just regular eating, which depends on where you live. Exercise, too, plays a role in treatment and longevity.

    With all these variables, should we put much stock in a study that looks at longevity from the perspective of just two therapeutic regimens? How well would a football team do with just two plays in its play-book?

    You’d think we would have a definite answer to the “tight versus loose control” issue by 2010. We don’t. It’s still very appealing to me to think that, if done right, tight control would yield the better outcomes. Problem is, we don’t always know what’s right.

    -Steve

    Posted by Steve Parker, M.D. |
  4. you know sometimes i think people try hard to be what they perceive their docs want them to be and don’t have a firm grip on what life is like day to day… those ups and downs are way harder on the body and we need to try to practice consistancy ..wherever that is for each one of us
    mary

    Posted by mary little |
  5. I would like to see more research that could give us “customized” A1C values to shoot for. This customization would take into consideration other health issues that affect one’s ability to control and maintain an appropriate glucose level that could aid in a healthy lifestyle that reduces the risk level for diabetic complications.

    Posted by Gayle |
  6. This article adds to the confusion! I’m not an MD or PhD, but I think the authors are reaching the wrong conclusion. Instead of raising A1C guidelines, it would be better to prevent low blood sugar.

    Lower A1C is better for your body - this is proven. (Chronic high blood sugar damages the body over time; therfore, “normal” blood sugar is a worthy goal.)

    With lower A1C does come a risk of severe hypoglycemia (low blood sugar) - which is the #1 side effect of most diabetes medications (used in this study) and a risk when striving to achieve lower average blood glucose #s.

    Yes, severe hypoglycemia can lead to diabetic coma or death; but, lower A1C doesn’t directly cause death. Lower A1C is a great thing, but requires vigilance to prevent episodes of low blood sugar.

    Hypoglycemia can be prevented by choosing the right foods to prevent low blood sugars. Eating frequent small meals throughout the day is one way to help prevent blood sugar lows, and reduce the risk of hypoglcyemia.

    Also, frequent testing of blood sugars can help spot a low before it dips too far. CGM also can help alert to blood sugar lows… if you can get your insurance to cover it.

    Posted by Jonathan |
  7. A 6.5 A1c for a type 1 diabetic sounds excellent.
    This can be an inaccurate guage of one’s overall control.

    Put simply, a very high blood sugar averaged against a very low BS could very often produce an A1c which sounds like this diabetic’s sugar is under excellent control when, in fact, his glucose levels are all over the place.

    This was my situation until I recently accuired a Continuous Glucose Monitor (CGM).

    I read everything I come across regarding Type 1 diabetes and have never seen this obvious fact in print.I find this outrageous.

    This is my 57TH year with diabetes
    Regards,
    Jim Devlin

    Posted by Jim Devlin |
  8. Latest reports link a B12 deficiency as the cause of risk of neuropathy and retinopathy , not elevated Glucose levels. Pratices that routinely give diabetics cyanocobalamin, see fewer case of neuropathy and retinopathy or delayed development.
    Part of the cause of B12 deficiency is reduced absorption due to metformin (a process depentant on Calcium) which is thought can be offset with a Calcium supplement.

    Posted by Joseph Swistok |
  9. I am a 70 year old type 2 diabetic. I use Metformin, insulin, and careful eating (MOST of the time) to manage my blood glucose levels. My A1c levels typically range between 6.2 and 6.4, with one at 5.8, achieved with a VERY focused effort. Unfortunately the achievement of that low (for me) level was associated with several hypoglycemic incidents, one of which happened while I was driving. Fortunately I can feel when such an event is coming on, but they come on very quickly, and there is great danger in that.

    My endocrinologist and I agree that I should work to manage my blood sugar levels to stay in the range of ca. 6.0 to 6.5 and not to try to get into a lower range where hypoglycemia is a serious threat. Since easing up a bit on control measures I have had only about two low blood sugar events annually.

    Dr. Parker’s comments resonate with my experience. I suspect that regular exercise (a least 30 minutes per day of walking, plus other phsyical activity) combined with reaching and maintaining an appropriate weight are more important than super tight control, and healthier. Those are ongoing challenges for me and probably for lots of the other readers.

    Posted by Jerome Weingart |
  10. I believe more study needs to be done, before any conclusion is made due to the potential problems incurred by accepting a higher level. The risks are too great to “jump the gun” so to speak.

    Rev. William Owen

    Posted by Rev. William Owen |
  11. The new guidelines sound great. I’ve always been told to try and keep my A1C at 7% or lower. The lowest I could get is 7.3. I am Type 2. My doctor has not yet changed the goal for me to reach.
    It is 7% or lower.

    Posted by Linda |
  12. Another really dumb study! I came to the conclusion years ago that the A1c isn’t necessarily the Almighty, but rather only an “average” indicator.

    From the brief summary of this study, little attention was paid to really avoiding extreme lows or highs. Perhaps a Study needs to be done where the participants tried to keep their glucose readings as close to normal as possible, without the wild swings. Me thinks the results would show a much different end result.

    Who ever designed this study did NOT have
    Diabetes and trying to save their butt. Perhaps they really think you don’t need to do a lot of tests everyday and modify your diet, etc. to keep tight control — Is it worth it? Well an A1c of 5.1 and the same weight as 30 years ago tells me it is! It does become part of one’s daily routine and somehow seems to puzzle my own doctor a lot — he’s been reading the studies I guess.

    Posted by John_C |
  13. I think it’s important to treat people, not numbers. Some people seem to flourish with very tight control; others are better off being more flexible. But how do you know what’s best for you?

    Probably you have to go by how you feel (especially your energy level) and some other numbers such as blood pressure. Quinn, did the Lancet study control for blood pressure? Because I can imagine people stressing out about their blood glucose might raise their blood pressure.

    David Spero, RN

    Posted by David Spero RN |
  14. I’ve always used the A1C percentage of 6.00% of lower as a basic daily guide for my level of glucose.

    Yes having the wiggle room of up to 7.00% is nice but my personality, discipline works better when my overall health benefits.

    My lab work results produce better/lower rates according to the standard set by the American Medical Association and American Diabetes Association.

    Is this difficult; yes but well worth your health.

    Thank you

    Posted by Sharon Todhunter |
  15. A very good and very critical analysis of this study by Jenny at Diabetes Update:

    http://diabetesupdate.blogspot.com/2010/02/lancet-study-old-patients-victimized-by.html

    She basically says the people who were put on tight control were sicker to start with, because the only way to for a Type 2 person to get on insulin in the UK is to have complications.

    David

    Posted by David Spero RN |
  16. What about PWD 2’s who control their glucose levels with exercise and diet without medication?

    Posted by micha |
  17. I appreciate the information and will ask my physican to check this out but like most of us we trust our physicians but sometimes wonder how current the information is that is presented. I think it behooves each of us to take this to them and get a reading.

    Posted by Sonny |
  18. I am a type 2 diabetic and have been diagnosed as of Dec. 1999. I am sure I must have had diabetes long before I was diagnosed, as my doctor always told me that I was borderline high. I am taking Metformin and watch my diet to keep my glucose results good. I was taking Amaryl along with the Metformin and was hypoglicemic most of the time. In fact, I had to go to the hospital by ambulance twice. The last time I went, my glocose read 32. That’s when my doctor took my off of Amyrl. My readings have been higher since then, but my A1c levels are still under 7.0. With the Amyrl, my A1c was in the range between 5.5 and 6.0. Now it’s always in the range between 6.0 and 7.0. I actually feel better and have lost weight. So in my opinion, this study really doesn’t reveal anything to make me change what I’m doing. I feel since everyone’s body is different, then the treatment needs to be given according to how each individual reacts to any given meds.

    Posted by Audrey Monroe |
  19. At 7.1% I’m sick as a dog most of the time with frequent hypoglycemic episodes.

    Generally speaking, I feel like a very expensive lab rat, always trying to hit some impossible number whether it is cholesterol, blood pressure, HbA1c, or weight chart… and being judge as some moral failure if I do not. Diabetes is a metabolic error, and obviously big business too.

    Anyone ever wants to examine why people are non-compliant, this is it. We’re not lazy, or stupid, or defiant…we’re tired of feeling like hammered mud all the time.

    This is living?

    Posted by Lula Brecka |
  20. It took a while for my doctor to bring my AlC under 7. Before that, I suffered with episodes of hypogycemia. Now, seldom does this happen. I don’t know if the A1C above 7 had anything to do with it, but I do know that others, like myself, may be able to keep the A1C under 7 and control hypogycemia. I would rather take my changes keeping it under 7 than living with it above 7. I would have to see more studies before I take the risks of possible long term effects.

    Posted by Rob |
  21. I was diagnosed with Type 2 diabetes in 1991. I am 87 years old. Over the years, I have used a variety of diabetes medications. Presently, i am taking just Lantus insulin (10 units per day). For some time, my primary care physician has been recommending A1C of 7.4 for me. Usually I am in the range 7.1 to 7.3. When I recorded A1C of 6.9 she told me that it was too low for me and wanted me to increase which I did. She is greatly concerned about low blood sugar.
    William

    Posted by William Prendergast |
  22. I would really like to see the studies a little more positive. I am a Type 2 Diebetic and I find it very hard to keep my A1C’s lower than 7% without having a lot of Low’s. I always stay between 7 and 7.8%.Maybe that is a better level for someone like me.

    Posted by Harriett Horton |
  23. I have had an average of around 7% A1C for several years. I do not have any eye or kidney problems, I did have a stent put in my left diagonal artery and have some neurapathy of the feet. I still have good pulses in the feet. I do see my endrocronolgist 3-4 times a year, my heart doctor once a year and recently had an angioplasty and the doctor found not blocked arteries. I feel the 7% is a good guide line. Further blind studies should be done to determine the side of effects of a higher A1C level.

    Posted by Nancy Blue |
  24. So…can I eat donuts or not?

    Posted by Kaztaylor |
  25. I think that we patients should invent our own methods and scales for setting A1C targets. The patient-oriented scales should take into account safety and quality of life issues, like, who is there at 3 a.m. to assist us during a severe hypo? Are we prone to severe bg drops 18 hours after exercise or on a certain day during the menstrual cycle? I’ve never met a doctor who was happy with my A1c, and conversely, no doctor has ever given a crap if I go through periods that I call hypoglycemic storms, where there’s one after another. We should set our own targets, and demand that our doctors give us what we need to achieve that. Not the other way around. My doctor “doesn’t know” how to go about getting CGMS for me. I was in the clinical trials to develop it. But my doctor still criticizes me and proclaims that I’m “high all the time.” She doesn’t hear a word I say. Quality of life in the present matters too.

    Posted by Susan Shaw |
  26. This article is very timely in my case. I have been a diabetic for almost 66 years. My most recent a1c had gone up in spite of the fact that I had lowered my average blood sugar of the past 2 months. I was very discourage; however, my Dr. was dellighted. Since obtaining a cgm (continuos glucose monitor) I have reduced the number of low BS. Hence the higher A1c. We are hopeing that in the future the A1c will look better….but is that really a necessary goal for everyone. I an also fighting the effects of anti-rejection medication. Since my transplant it has been very hard to control my BS. But I continue to work hard at being the best I can be.

    Posted by Kenneth Schmidt |
  27. I think more study about A1C levels should be exercised. I would like to know what my goal is or should be. My doctor would like my A1C to be between 6 to 7. Is this good or not? Now I am more confused than informed.

    Posted by Tammee |
  28. One of the most frustrating things about managing type 2 is all the conflicting reports and recommendations you receive from many different sources. There does not seem to be one good recommended plan for managing this disease.

    This just adds to the confusion. Very disappointing to hear about this report.

    Posted by Richard |
  29. This is really very confusing to me. I would like to know whether age factor may play a role in determining the HbA1c level. In persons of 75+ age group the amount of insulin secreted may not be at the level secreted in middle age or younger groups. So in such persons naturally the HbA1c factor should be higher say 7 and above. Only researchers who have worked with persons of this age group (75 and above) should be in a position to tell what should be the the level of HbA1c for this higher age group. Myself who is declared as Diabetic Type 2 patient for little over five years is having the HbA1c at 7.1 when I was tested couple of weeks back and my personal physician says since other parameters such as cholestral, BP etc are normal he asked me to continue to take only one tablet of GP1 tablet daily half an hour before breakfast and continue to have daily walk for half an hour to maintain my normal health.

    Posted by Dr. G V Rao |
  30. I am a type 2 on a sulfonylurea (glipizide er).
    My doctor has my target A1c at 6. I have averaged between 5.3 and 5.7 for the better part of 2 years - one quarter I went up to 6.3. I work very diligently to avoid hypoglycemic episodes by eating as controlled and regular a diet as possible. As a result ‘lows’ are generally not a problem for me. It also helps that I am very in tune/sensitive to my ‘going low’. As an earlier post mentioned, ‘grazing’/snacking helps to avoid crashes.
    I am not a medical professional, but feel the case is still strong for keeping targets low to avoid the eventual complications from high BG levels. Most of the posts here don’t lead me to think differently.
    Anecdotally, I feel better when in tight control to the low side rather than trending /averaging high #’s.

    Posted by sunburst1969 |
  31. This is very interesting. I had a doctor who once told me I was cured because my A1C was under 6. and took me off meds…When I went to him with numbers over 300 (for a salad), crashing to 40s, his response was so ” your A1C is good” of course I told him how stupid that sounded and he was fired.

    I now have a great doctor who has informed me, that yes she will do the A1C as a guideline, but she wants to see my numbers, and to try and keep them at the range she wants. I am maintaining a 5.3 but she has said she will not worry about this if it gets a bit higher where she would actually like to see it.

    My husband has had an A1C at 6.0 - 6.3 for 30 years, he has always had this, tho at one time he was perfect before they decided to lower the standard, now his doctor seems to think he is pre-diabetic and is constantly seeing him every 3 months, which I think is overkill. I test him every so often to spot check and considering what he eats and the carb content, and from my doctor’s response to this, his numbers are great, never fluctuates. He is on 3 meds that affect bg numbers, he has severe heart disease and other medical issues, even has a cpk that is off the charts which Mayo clinic cannot figure out why…was told some people just do not fit the norm.

    Posted by Gayle Burns |
  32. This is not a study, it is the output of the data fed to it. It is the first that I can recall as having a good conclusion. I will admit that I am biased as I have never thought tight control was a good idea. Good control is. If you hypo, you are doing it wrong. A simplified statement that people can understand.
    Forums are full of people competing with themselves and each other for the lowest number possible. Testing constantly. Having around 7 has been fine with me. No meds and no complications after 5 years tell me I am onto something.
    This will be hard for a lot of people to grasp. we live in a world of if something is good, then more must be better. And a lot more is great. And to be the first to jump on a bandwagon.

    Posted by Ray |
  33. I have been assisting and observing my 81 year old mother control her diabetes for the past six years. If her level goes below 7%, she then has several days of fluctuation with drops down to 34, 35. When her sugar is stable, she is slightly active, alert and coherent. When her sugar is a little high, 160’s to 190’s, she has more energy and becomes more engaged. It is hard to describe, but it is as if she has dropped ten or fifteen years.

    Posted by Lori C |
  34. Seems that the point of converting A1c to an average blood glucose number is not being addressed. Perhaps people would respond better to comments based on a blood sugar reading of 154 rather than A1c of 7%. Isn’t the idea to “normalize” a body that is out of the normal performing range? We certainly would take our car in if the oil pressure is above the range that will protect the engine so why would a human being be any different.

    We do this with hypertension, heart rate, kidney function, vision etc. If we are not functioning with the normal human being ranges, we go get it fixed or altered to get w/in the proper range in order to decrease the liklihood of an engine malfunction..such as kidney failure, neuropathy, blindness, amputation, stroke, heart attack, etc…

    To say that it is acceptable to operate outside of the normal range of known standards makes no sense. Strive to be in control by operating within the known ranges! Don’t accept anything less since after all, it is your body/your life. Peace…

    Posted by Mark Hanshaw, PharmD |
  35. There are too many variables listed here to use this as a reason to not lower your A1c level. More studies need to be done with a much closer control group with controlled variables before people start believing they can start raising their levels and not be at risk. This kind of study just makes diabetics more confused and less compliant, saying doctors don’t know what is best when this study is not scientific or accurate!

    Posted by Alice Turner |
  36. I WOUI QUESTION STRONGLY THE FINDING THAT A LOW LOWER HBA1C CREATES A HIGHER INCIDENT OF DEATH.
    WITH OUT THE INCLUSION OF THE TYPE OF MEDICATION
    USED AND EXISTING HEART,LIVER AND KIDNEY PROBLEMS
    LEMS THAT WERE THERE.I.E METFORMIN VS ACTOS
    OR BYETTA IN CCOMBINATION WITH EACH.A RECENT
    STUDT OF 95.000.PEOPLE FOUND THAT THOSE ON CLYGLIPERIDES HAD A 39-60 JIGHER DEATH RATE
    THEN THOSE ON METFORMIN BUT CONCLUDED
    THER WAS NO CAUSE AND EFFECT SHOWN.
    TILL THEY SHOW CAUSE AND EFFECT I AM FOR
    THE LOWER HBA1C.

    Posted by DON MARLOW |
  37. I understand haveing a constant blood sugar and staying under control! Wide-large fluctuations over a period of time can and will be damaging! However if my H1c is below 7 then I am at a constant low level which is even more devestating! I don’t even try to be below 7 and I feel and do just fine! I am tired of one thing being good and then it is bad I feel with diabetes EVERY person is different!! A 43 year diabetic with relatively few problems!!!

    Posted by John Butterworth |
  38. All of these small studies are limited and confussing (and samples of less than 100,000 over short time periods are small when mortality is an outcome of interest!). Variations in characteristics of the study populations, theraputic agents, and treatment centers makes comparisons difficult. What we need are more ongoing well analyzed registry studies that involve millions of diabetic persons real-life experiences. This is a problem created by the drug companies and the FDA in the way they manage drug safety testing.

    Hopefully if the most recent efforts to implement electronic health records work properly, these sort of well done large sample registry studies will replace health decision making based on poorly done human experimentation.

    Posted by Mark Gottlieb |
  39. I believe you should consult your doctor on any change in goals.
    I am a type 2 diabetic and believe that daily
    walking or some form of exercise is necessary.
    A diet counting carbs is beneficial.I have a
    a1c of 5.8.
    If I do not exercise,[I walk 2 miles about 4 times a week average].my a1c goes up no matter what my diet.
    Walking is key to my 5.8.I check my blood sugar
    randomly unless I stop walking.
    weight loss and exercise are most important for me.
    I do not put much thought to these studies as they only lead to confusion.
    consult your medical professional and keep your
    own counsel.
    Wish all of you success in your goals.

    Posted by Jim Fox |
  40. My husband was DX’d in 1982 and I was DX’d in 2002 (we are now both insulin-dependent…our beta cells “crashed”). We both went to a diabetes education clinic - where I subsequently volunteered for 4.5 years. Those years were a wonderful experience for me because one of the most meaningful things I learned was with diabetes “one size DOES NOT fit all. (With some 24 million of us diabetics out there how could one set of A1C numbers fit all of us!!) My personal opinion is that the A1C numbers of between 7% an 6% present a moderate, reasonable, and healthful guideline of where we perhaps should be BG-wise. However, some of us may need to be a bit over or a bit under those percentages. For example, my husband is almost 86 years old and our doctor would rather have his A1C around 7 - 7.5% because he doesn’t want my husband going hypo,falling and perhaps breaking a hip or other bone(s). (He’s had some scary hypo incidents that were in the 20’s and 30’s - thank goodness for the paramedics.) For me, ranging between 6.5 - 7.0% is good control. Some days the diabetes is in control no matter what we do - other days we’re in control and we may or may not hit the desired A1C mark. With diabetes, it’s just not a perfect world. As long as over-all we’re both in control, that’s a winning situation for both of us.

    Posted by Virginia |
  41. I am confused by the A1C in general– what does 7.0 mean? does that mean my average bloodsugar is 120-140? I have heard of some diabetics who have A1Cs as low as 2- I can’t even phathom that! I am at 6.4, and the nurse at my clinic told me her new advice was to have it as low as 4.5! If I had my blood sugar lower than it is now, I am not sure it would be safe for me to be driving….

    Posted by Sher |
  42. David, in response to your blood pressure question: I assume that blood pressure was considered when calculating cardiovascular risk, which was controlled for. But of course office blood pressure readings might not be the same as usual blood pressure. I think your larger point about treating patients, not numbers, is important since no study can predict an individual’s reaction to a treatment. But when we’re talking about preventing complications through a treatment, what guide can there be other than large studies?

    Susie, this study did not look at blood glucose swings at all, which may be yet another overlooked factor in the results. It would certainly be interesting to do a study looking at both HbA1c and blood glucose variability (perhaps using a continuous glucose monitor) to see how important each one is in preventing complications and death, but I suspect that this would be extremely complicated and expensive.

    Posted by Quinn Phillips |
  43. I am a type 2 controlled by diet and I find that if my HA1C goes below 6.5 and my BS is in the 70-80 range I feel worse and do suffer from more low BS episodes

    Posted by diane bilansky |
  44. i also think that a1c’s should be based on each individual persons needs and characteristics. when my bloodsugar drops even a bit below 100 i feel forgetful and absent minded as if i were on the way to being low or already were. i tend to keep my sugar around 140 (not that my doctor has liked this) but I know i function better at this level. i have never had any complications for the past 22 years. im glad i can say that now and i know that doesnt mean the next 22 years will be the same but im not going to let this dictate how i live.

    Posted by mandy |
  45. In my last lab work my HA1c was 8 a 2 point higher than my last.I don’t understand why I have a hard time controlling my BS. I cut my intakeof sugar producing foods but still BS is the same. When I try to cut my food intake, I go into hypo and it scares me, I shake and then try to eat as much sugary food asap to stable myself. I would feel weak and sleepy so I feel terrible.

    Posted by Nympha Werring |
  46. This is very confusing. I am a type 1 and to get a lower A1C than 6.0 is unrealistic, for me anyway. I also want to mention, ( a little off topic ) if you watch Dr. Oz, he tells people that a blood sugar of 100 or higher they are diabetic. As I recall, the ADA says that pre-meal numbers of 70-130 are acceptable and post meals 180 or lower are acceptable. I’d like to know when he takes these numbers. A reading of 100 in my way of thinking is a very good number. I think he is scaring people telling them they are diabetic when in fact, they most likely are not.

    Posted by Brenda |
  47. I was diagnosed in 1996 as Type 2. Additionally, I have had many bouts with pancreatitis (no alcohol) and hyperlipedemia (triglycerides as high as 4900, now @ 450) I’ve gone through the majority of the oral meds and either they just don’t work for me or any that stimulate my pancreas in any way can’t be used. I limit my carbs to 30 or less grams at least 5 out of 7 days and currently take 70 units of Lantus and 30-54 units of Apeidra daily. After losing 65 pounds, my BS averages 300 and my A1C is around 13. Prior to the weightloss, I was averaging 220 and 10.
    With all the contrasting info we get, WHAT are you supposed to go with?????????

    Posted by Patrick Wilson |
  48. I was in the ACCORD group that sought the HBA1C of <6. Iknow I functioned better when I got to that goal. I am a researcher and I could reason, analyze data and write better at that goal. When the study goals suddenly changed and wanted me to be at 7, it made a noticeable difference in my ability to function professionally.
    Because of this, here is what I believe: There can be certain guidelines, but the best results will come for people who use those guidelines as a help to find their own, personal best HBA1C. I don’t think this is a one size fits all situation.

    Posted by Sharon S. |
  49. I totally agree with Sharon and I thank her for her input.

    I have found I am the best ‘decison maker’ of my medical needs. However, this is ONLY after consulting with doctors, reading different articles and talking to others with Diabetes. I am Type II and not a good patient as far “as following the rules”. I watch my sugar level, I get my blood work done consistently (except 1 3-month period when my Mother passed) and know exactly what my body is telling me.

    Posted by Kathy |
  50. Sometimes I think those of us with diabetes are just guinea pigs. If my sugar is below 100, I am shaking, heart pounding. I keep gaining weight and the more insulin is added, the more weight.
    If I stay off red meat and dairy products, the sugar goes down. Last AIC was 7.8, trig 94 and
    chol 124. I am in my 70’s

    Posted by Nelda Muirhead |
  51. Clear as mud.

    Ben Koshkin

    Posted by Ben Koshkin |
  52. Diagnosed type2 in ‘93. Followed the docs advice and meds since that time. When they started the insulin at min.doses, i started with very low bs and episodes where i felt i might not survive.

    my experience tells me and i feel low episodes are worse for you than high. like one lady said, rapid hb, sweating, salivating, ready to pass out cannot in any way be the way to go.

    until they come up with something that works and you can live a good quality of life, their remedies thus far, do not work for me.

    Low a1c below 7 and 100 bs is a horrible way to live for me. i cannot function. this is no way to live. higher levels give me energy and a better quality of life.

    this treatment has just made me want to quit all meds until they figure this out and i do not want to be a guinnie pig any longer. these reports just confirm to me that it is all about the money not about the patient. if the uk does not treat with insulin there must be a reason because when it comes down to cost and effectiveness is where the rubber meets the road and it shows it treatment we can probably survive quite long and well without in this situation. we tend to go too far with more treatment because we can afford it, rather than based on what we really need and what works. this is not working, more heart attacks due to too much insulin and its negative reactions. i could not even sleep at night with my heart pounding everytime i took the shots and the doctor just wanted me to keep going with the insulin?????????? i also had exreme weight gain, sleeplessness, pounding heart, dry skin etc.

    I am off meds and I feel better, am losing weight, heart is not pounding, sleeping soundly, skin is not so dry, clear head/thinking even with the high bs, so many good results. This is what my research has proved to me. Teresa

    Posted by Teresa Harrell |
  53. First of all, there seems to be no consensus about the normal range for HbA1c. And let’s remember that it is a 3 month average and hence trying for a lower value has the risk of hypo on a consistent basis to offset the higher values. Those who have experienced hypo (like I did a couple of times)will certainly not forget it for some time to come. It is not a pleasant experience what with fingers shaking, stomach crying for some food and quite unsettling to move around. To have it on a regular basis is a recipe for disaster, atleast psychologically.

    I have my own concerns about the sanctity of these values and the ranges that have been set. Surely, human beings do not keep changing their constitution to accommodate varying normal values.
    A popular theory is that the values are manipulated to get more people identified with diabetes and hence higher business for everybody and there is some merit in that.

    Trying to over-emphasise the test readings and results is not healthy at all (not that we ignore them totally). Ultimately, it is how healthy we feel that really matters and only we can be the best judge of that. If we feel uneasy and yet tell ourselves that everything is fine, then we are only cheating ourselves and there can be no remedy for that.

    And we and our physicians need to look at our results in a holistic manner rather than just the last reading. Just reacting to a high value with more medication or lowering the dose if the result is satisfactory is counter-productive for the patient. We have created a software called DiaSof at our website which generates charts and reports of our results (fasting, post prandial and hba1c) over time giving a better overview of our control (or the lack of it).

    Posted by Badri |
  54. It takes a simple logic to prove that the idea of “higher a1c is better” is WRONG.
    To raise hba1c, is to raise blood glucose level after meals To raise glucose level is by consuming a lot of carbs and sugar.
    Therefore, suggesting higher a1c is like suggesting diabetics to eat a lot sugar. How ridiculous is that?

    Posted by redian |
  55. The A1c number is an average of some high and some low numbers. Trying to reduce the A1c after having high bs levels will give many people hypoglycemia as others have pointed out. It is all a balancing act which demands watchfulness on the part of the patient. You learn from what your body tells you, what information you can find to read, conversations with your health care professionals and other diabetics.

    Posted by Patty |
  56. I was diagnosed with Type 1 in 1975 back when the only self management available was urine tests and insulin came from pigs. I remember going to the clinic with my 24 hour urine sample - ah yes the good old days. Now with CGMS and all the new fangled technology one would think self management and maintaining good control would be much easier but it really isn’t. My last A1C was 6.2 and that for me is a historic low. The only time I have ever been lower than that was just after giving birth to my 5 pound 1/2 ounce baby boy, then it was 5.9. But getting to 6.2 was a lot of work and involved far too many lows. To be honest I am a lot happier when my A1C is in the middle 7’s and my doctors were pretty much ok with it too. Trying to achieve non-diabetic A1C levels is unrealistic and can be dangerous if one is hypoglycemic unaware.

    Posted by Clare |
  57. my father is a diabetic and recently he had several episodes of hypoglycemia at evenings. He is on metformin 1gm bd nd n insulin -human mixtard 30IU in am and 25IU pm.
    Due to the complains we have done a blood study which showed FBS-81, PPBS- 244 and HbA1C - 10.1%. Please advice how can he control the diabetes and make the hba1c value to normal level

    Posted by bikku |

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