Here at Diabetes Flashpoints, we’ve discussed the evidence supporting higher or lower targets for HbA1c (a measure of long-term blood glucose control). Studies have shown that in certain groups of people with diabetes — namely those who are older or sicker, or who tend to experience hypoglycemia (low blood glucose) — a somewhat higher HbA1c level than what’s normally recommended may lead to better health outcomes. Since this evidence has been accumulating over time, researchers at Tufts Medical Center in Boston sought to find out how HbA1c recommendations have changed in recent years, and whether they tend to be related to certain characteristics of people with diabetes.
The resulting study, published in June in the journal Diabetes Care, involved 1,782 people with diabetes who were interviewed between 2005 and 2013 and answered the question, “What does [your doctor] say [your] ‘A1C’ level should be?” Only 54% of participants provided a number; the rest said they didn’t know, or that they didn’t have an HbA1c target. Among those who did respond with a number, responses were grouped into three categories: less than 6%, less than 7%, and higher targets.
The researchers found that only 4% of the participants reported an HbA1c goal higher than 7%. They also found that in most ways, participants who weren’t sure about their HbA1c target — or didn’t have one — weren’t much different from participants who did have an HbA1c goal. The biggest difference among these groups was that 26% of those who reported that they didn’t have a target number were over 75 years old, while the percentage of people in this age group was lower among those who provided a target HbA1c or didn’t know it.
There was some good news in the study: The percentage of participants who didn’t know their HbA1c goal declined from 30% in 2005 to 10% in 2013. But there was also bad news, including that 70% of participants who didn’t know their HbA1c goal were nonwhite — a significantly higher percentage than in the groups that knew their target or didn’t have one.
Perhaps the most disappointing result of all, though — as noted in a Physician’s Briefing article on the study — was that among participants who knew their HbA1c goal, there was no correlation between target HbA1c and characteristics such as age, sex, medical history, physical activity, disability level, or physical or mental health. This complete lack of correlation suggests that doctors aren’t basing HbA1c recommendations on an individual patient’s situation, but rather simply recommending the same number to most or all of their patients.
The American Diabetes Association, in its 2016 Standards of Medical Care in Diabetes, states that doctors “might reasonably suggest more stringent A1C goals” such as less than 6.5% in people without significant hypoglycemia, with a short duration of diabetes, or with Type 2 diabetes that’s treated through lifestyle treatments or metformin alone, among other factors. It also says that “less stringent A1C goals,” such as less than 8%, may be better for people with a history of severe hypoglycemia, short life expectancy, advanced diabetes complications, or other severe ailments, among other factors.
What’s your take on this study — do you think you and your doctor considered your personal situation when setting your HbA1c goal? Do you know what your HbA1c goal is, like 54% of the people in the study, or are you not sure or don’t you have one, like the other 46%? Do you find it difficult to reach your HbA1c goal, or do you often experience hypoglycemia while trying to do so? Or do you meet your goal so regularly, and without problems, that you think a lower target might be achievable? Leave a comment below!