The HbA1c for Dummies

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Comment by Jim Montgomery on November 11, 2009 at 8:57pm

HbA1C - not yet ready for diabetes diagnosis
Recommendations to use haemoglobin A1c as a sole laboratory test to diagnose type 2 diabetes are premature, according to international experts including Australia’s Professor Paul Zimmet.
Paul for those who don’t know him: http://tiny.cc/KhiVt
Writing in the BMJ, they noted that a committee representing the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation had suggested an HbA1c of 6.5% or more should be sufficient to define the presence of diabetes without the need for a fasting blood glucose level or oral glucose tolerance test.
They go on to note: “The level could also be affected by iron deficiency anaemia, renal failure, medications including antiretrovirals, and”, the point I have been making for some time, “advancing age.”
They conclude “Like a fasting blood glucose level of 7 mmol/l, the proposed HbA1c threshold of 6.5% for a diagnosis of diabetes was arbitrary and needed further discussion.”
For those without a subscription to the BMJ –an overview can be found in "Endocrinology Update" [published by The Lancet] http://tiny.cc/kHEXK

Comment by Gerri on November 5, 2009 at 5:32pm

Don't who Sugar Stats is, but they are dead wrong. Anyone can post a site & it doesn't mean they know what they're talking about. Tons of misinformation on any sunject. What credentials do they have? I'd like to contact them. Great that they recommended Tu D & Manny.

Comment by Jim Montgomery on November 5, 2009 at 5:23pm

Gerri
I think we are boring the pants off other people –you have your opinion and I have mine –albeit mine is from a very practical, hands-on, T2 approach.
I can quote you one US reference immediately from an online source called SugarStats –who incidentally recommend both Manny and TuDiabtes as a source –and maintained by well credentialed people.
“What is a normal HbA1c level?
Well, in non-diabetics, a normal HbA1c level is between 3.0% to 7%”.
http://www.sugarstats.com/2007/02/14/hba1c-tests-the-results-and-what-they-mean-to-you/
I certainly don’t recommend the HbA1c as an alternative to regular home testing –as an average there are just too many variables that could result in a ‘good’ HbA1c.
Now I suggest we put it to rest.

Comment by Gerri on November 5, 2009 at 4:27pm

You've something as fact, though an incorrect one: "a normal HbA1c level is between 3.0% to 7%." This is not normal A1c range & I'd like to see one reputable source that states this from any country.

There's sufficient research showing that the closer to normal A1c's are, the less complications people have. No point in arguing this since the studies speak for themselves, if you'd like to research this for yourself. If studies aren't enough, commonsense dictates that high BG as evidenced by high A1cs aren't healthy. Over 140 causes damage & this is a fact.

Comment by Jim Montgomery on November 5, 2009 at 3:59pm

Aaaaaaaaaaaaah!
“People should be given the facts to decide for themselves”
But who decides what the facts are?
Who is to say that the UK DA and the American DA are wrong and that the IDF is right?
Who has the credentials to be the final arbiter?
As I said in my original piece under the heading of “What HbA1c do I aim for?” “Your doctor will advise.
And I can assure you, from personal experience, that answer will be different in Sydney, Mumbai, New York, Auckland and Beijing.
I did spend a dozen years in the US, my youngest daughter was born in Florida. I am well aware of the shortcomings of your current system and am happier to live as a diabetic Down Under.

Comment by Gerri on November 5, 2009 at 3:29pm

Not sure that people in the US have the "luxury" of lowered targets with many having no health insurance, health insurance that covers little of the expense & soaring unemployment. Your medical care is dependent on what the government deems. In the US it's insurance companies making profit. Under either system, people often don't receive what they need. There are many discussions from US members who can't afford meds & doctors, along with numerous stories of substandard care.

It's problematic to tell people that 7% is acceptable when lower is attainable & is realistic & in their best welfare. Having lowered standards is a disservice & gatekeeping of critical information that effects well-being. The closer an A1c is to normal, non-diabetic ranges, the better. No, we can't be normal, but striving for good control is the goal. Why shouldn't people be motivated to do what's in their welfare? Why should they settle for good enough, particularly when they're not being given incorrect info? People should be given the facts to decide for themselves.

Unfortunate that the UK standard is a goal of less 7.5% when the IDF recommends below 6.5%, as Melissa wrote.

Comment by MelissaBL on November 5, 2009 at 2:09pm

The International Diabetes Federation recommends targets below 6.5% as well, and they are an international organization.

I'm not saying that 7.0 is necessarily unhealthy for a diabetic, just that it is not optimal for reducing the risk of complications. In the States, I had to have my A1c below 6.5 to become pregnant.

Comment by Jim Montgomery on November 5, 2009 at 1:01pm

I stand by what I wrote –you call the ADA target figure of below 7% as too high; you may be interested to know the UK figure is “National guidelines are to have an HbA1c of less than 7.5%.” http://www.leedsth.nhs.uk/sites/diabetes/tips/HbA1c.php
I prefer to deal with realistic targets that the average person has a hope of reaching. Motivation is a critical factor in lifestyle changing. Perhaps in the US you may have the luxury of the preferred lower targets. For most of the world, treatment is confined to a GP, if they are lucky, and treatment is based on what the government is willing to support.
Obviously we have different normals.

Comment by MelissaBL on November 5, 2009 at 8:15am

I agree with Gerri! I have never seen it indicated from a reputable source that non-diabetics have such a wide and dangerous range. 4.0-5.9% is the normally quoted non-diabetic range, which coincidentally is what diabetics should be striving toward as well. The ADA goals of below 7% are famously high and we can all attest to that, with the AADE recommending below 6.5% - which is a good deal better.

It is important for all diabetics to understand that blood sugars over 140 mg/dL cause cellular damage. An average as high as 7.0% (or 155 mg/dL) means that we are too high over half of the time. To avoid complications, tighter goals closer to non-diabetic ranges are the true aim, ideally achieved with few hypos and a tight standard deviation from the mean.

Comment by Gerri on November 5, 2009 at 1:15am

Normal A1c is not between 3-7, as you state. Again, where did get this? Please do your research before putting forth info like this. Any doctor should most definitely act on an A1c of 7, an average BG of 155. Damage happens at BG over 140. Normal BG is in the 80's. Any clinician would also take action on anyone who's A1c is 3 (severely hypoglycemic).

The ACCORD study mentioned in your link was extremely flawed.

Diabetes Update: Smoking Gun: Did Avandia Kill those ACCORD ...Doctors in the US have been told the ACCORD study "proved" it was dangerous for people with diabetes to shoot for a 6.5% A1c. ACCORD study found that a ...
diabetesupdate.blogspot.com/.../smoking-gun-did-avandia-kill-those.html - Similar

Diabetes Update: A Giant Step Backwards: Misinterpreting ACCORD ...If you'll remember, ACCORD was the study where they took people who had diabetes and preexisting heart disease , put them on every drug possible, ...
diabetesupdate.blogspot.com/.../giant-step-backwards-misinterpreting.html

Diabetes Update: ACCORD Redux: Low A1c Does Not Raise Risk of DeathACCORD was the large study that supposedly found the correlation between lowering A1c and increased risk of heart attack. A very similar study, ADVANCE, ...
diabetesupdate.blogspot.com/.../accord-redux-low-a1c-does-not-raise.html - Similar

Diabetes Update: How ADVANCE differs from ACCORDFeb 24, 2008 ... One, ACCORD, appeared to find that lowering the average A1c of a group of participants to 6.4% slightly increased the cardiovascular death ...
diabetesupdate.blogspot.com/.../how-advance-differs-from-accord.html - Similar

Diabetes Update: When The Doc Says Lowering A1c Below 7% is DangerousMar 27, 2009 ... A Giant Step Backwards: Misinterpreting ACCORD Harms People with Diabetes ... Are you aware that ACCORD and ADVANCE both found that lowering ...
diabetesupdate.blogspot.com/.../when-doc-says-lowering-a1c-below-7-is.html - Similar

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