Are The Ada’s A1c Target Recommendations For Type 2 Diabetes Patients Too Conservative Or Is The Aace/ace Consensus Statement’s Approach Too Aggressive
Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose and A1C determinations.1,2 The American Diabetes Association recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendationsand associated management philosophyto which the treating clinician adheres.
Take Note
- According to ADA guidelines, the standard A1C goal for adults with T2DM is 7.0%, but this can vary depending on individual patient profiles.
- The AACE/ACE recommendations are more aggressive, with a target A1C of ?6.5% to minimize risk of diabetes-related complications.
- Until large clinical trials utilizing newer therapies are done to evaluate the risks and benefits of intensive therapy, it is likely that the ADA and AACE/ACE recommendations will continue to differ.
According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2
Conversely, the ADA suggests a target A1C of closer to 8.0% for individuals with any of the following:
What Does Hba1c Mean
HbA1c is whats known as glycated haemoglobin. This is something thats made when the glucose in your body sticks to your red blood cells. Your body cant use the sugar properly, so more of it sticks to your blood cells and builds up in your blood. Red blood cells are active for around 2-3 months, which is why the reading is taken quarterly.
A high HbA1c means you have too much sugar in your blood. This means youre more likely to develop diabetes complications, like serious problems with your eyes and feet.
Knowing your HbA1c level and what you can do to lower it will help you reduce your risk of devastating complications. This means getting your HbA1c checked regularly. Its a vital check and part of your annual review. Youre entitled to get this test at least once a year. But if your HbA1c is high or needs a little more attention, itll be done every three to six months. It’s really important not to skip these tests, so if you haven’t had one in over a year contact your healthcare team.
Once you know your HbA1c level, its important that you understand what the results mean and how to stop them from getting too high. Even a slightly raised HbA1c level makes you more at risk of serious complications, so get all the facts here and be in the know about HbA1c.
Professional Organization Take Issue With Acp’s Proposed Changes To Hba1c Goals
The Endocrine Society, American Association of Clinical Endocrinologists, American Diabetes Association, and the American Association of Diabetes Educators have issued a harsh rebuke to the ACP guidance, which proposed that it may be more beneficial to relax current goals for nonpregnant adults with type 2 diabetes.¹³¹
“While there are several topics listed in the American College of Physicians statement on which we agree, there are several significant areas that do not align with ADAs 2018 Standards of Medical Care in Diabetes,”¹³ according to the ADA press release.
One main criticism the ADA raised about the ACPs guidance is that it does not consider the positive legacy effects of intensive blood glucose control confirmed in multiple clinical trials, and therefore, are not reflective of the long-term benefits of lower A1c targets.¹³
The ADA argued, “There is clear, convincing evidence of a long-term reduction in diabetes complications with A1cs at and below 7 percent. ADA is also concerned by the missing consideration of the positive impact of several newer medication classes that are associated with low risk for hypoglycemia have favorable effects on weight and improved cardiovascular disease outcomes.”¹³
In the end, patient-centered care will determine the best approach to care something about which both professional organizations could agree.
As if to break the tie, Dr. Ende said, Ultimately, we have to take the lead from our patients.
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What Can Affect Your A1c Results
Anyone whos had diabetes for any length of time knows that A1C tests havent been reliable until recently. In the past, many different types of A1C tests gave different results depending on the lab that analyzed them. But the National Glycohemoglobin Standardization Program has helped improve the accuracy of these tests.
Manufacturers of A1C tests now have to prove that their tests are consistent with those used in a major diabetes study. Accurate home test kits are also now available for purchase.
But accuracy is relative when it comes to A1C or even blood glucose tests. The A1C test result can be up to half a percent higher or lower than the actual percentage. That means if your A1C is 6, it might indicate a range from 5.5 to 6.5.
Some people may have a blood glucose test that indicates diabetes but their A1C is normal, or vice versa. Before confirming a diagnosis of diabetes, your doctor should repeat the test that was abnormal on a different day. This isnt necessary in the presence of unequivocal symptoms of diabetes and a random sugar over 200 mg/dl.
Some people may get false results if they have kidney failure, liver disease, or severe anemia. Ethnicity can also influence the test. People of African, Mediterranean, or Southeast Asian descent may have a
changes in lifestyle can make a big difference and even put your diabetes in remission. Starting an exercise program can help. Type 1 diabetes needs insulin treatment as soon as its diagnosed.
What Do Your A1c Results Mean
The A1C test measures the glucose in your blood by assessing the amount of whats called glycated hemoglobin. Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin, Dr. Dodell says.
According to the ADA, A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes, according to the ADA. Type 2 diabetes is diagnosed when the A1C is at or over 6.5 percent. For many people with type 2 diabetes, the goal is to lower A1C levels to a healthier percentage.
Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and any other heath conditions you have. A common A1C goal for people with diabetes is less than 7 percent, Dodell says. If you can keep your A1C number below your goal, you help to reduce the risk of diabetes complications, such as nerve damage and eye problems.
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Do You Have To Fast For An A1c Blood Test
Unlike the fasting plasma glucose and the OGTT tests, there is no need to fast before having the A1C test. If A1C test results indicate a person has or might have diabetes, a healthcare provider might suggest one of these tests to confirm the results. Another test, the random plasma glucose test, which does not require fasting, can also be used. If the results are borderline or if the results of the different tests do not match, a doctor might suggest repeating the test in several weeks or months.
Rethinking A1c Goals For Type 2 Diabetes
- By Monique Tello, MD, MPH, Contributor
“Treat the patient, not the number.” This is a very old and sound medical school teaching. However, when it comes to blood sugar control in diabetes, we have tended to treat the number, thinking that a lower number would equal better health.
Uncontrolled type 2 diabetes is associated with all sorts of very bad things: infections, angry nerve endings causing chronic pain, damaged kidneys, vision loss and blindness, blocked arteries causing heart attacks, strokes, and amputations So of course, it made good sense that the lower the blood sugar, the lower the chances of bad things happening to our patients.
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Professional Organization Take Issue With Acps Proposed Changes To Hba1c Goals
The Endocrine Society, American Association of Clinical Endocrinologists, American Diabetes Association, and the American Association of Diabetes Educators have issued a harsh rebuke to the ACP guidance, which proposed that it may be more beneficial to relax current goals for nonpregnant adults with type 2 diabetes.13 ,14
âWhile there are several topics listed in the American College of Physicians statement on which we agree, there are several significant areas that do not align with ADAs 2018 Standards of Medical Care in Diabetes,â13 according to the ADA press release.
One main criticism the ADA raised about the ACPs guidance is that it does not consider the positive legacy effects of intensive blood glucose control confirmed in multiple clinical trials, and therefore, are not reflective of the long-term benefits of lower A1c targets.13
The ADA argued, âThere is clear, convincing evidence of a long-term reduction in diabetes complications with A1cs at and below 7 percent. ADA is also concerned by the missing consideration of the positive impact of several newer medication classes that are associated with low risk for hypoglycemia have favorable effects on weight and improved cardiovascular disease outcomes.â6,13
In the end, patient-centered care will determine the best approach to care something about which both professional organizations could agree.
As if to break the tie, Dr. Ende said, Ultimately, we have to take the lead from our patients.
Is The A1c Test Used During Pregnancy
Health care professionals may use the A1C test early in pregnancy to see if a woman with risk factors had undiagnosed diabetes before becoming pregnant. Since the A1C test reflects your average blood glucose levels over the past 3 months, testing early in pregnancy may include values reflecting time before you were pregnant. The glucose challenge test or the oral glucose tolerance test are used to check for gestational diabetes, usually between 24 and 28 weeks of pregnancy. If you had gestational diabetes, you should be tested for diabetes no later than 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. Even if your blood glucose is normal, you still have a greater chance of developing type 2 diabetes in the future and should get tested every 3 years.
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Why Does A Person Need To Test Their Blood Sugars If They Can Get An A1c
The A1C is only an average blood sugar reading. This can be made up of highs and lows. If someone is on a treatment that doesnt cause lows , then they dont need to do blood tests as often and the A1C is fairly representative of their average blood sugar. However, blood testing will give specific information on the pattern of their blood sugars, showing when they are high and low, and what lifestyle factors such as food and exercise cause them to be higher or lower.
If a person is on insulin, self-monitoring their blood sugars is extremely important because it can give moment-to-moment information on how to adjust insulin. If a persons blood sugars are out of range, then testing gives information on what time of day to target therapy. For instance, if the morning numbers are higher, they may need nighttime insulin. Or if the morning numbers are at target but blood sugar is high after supper, they may need more medication at suppertime.
Hba1c Is Your Average Blood Glucose Levels For The Last Two To Three Months If You Have Diabetes An Ideal Hba1c Level Is 48mmol/mol Or Below
If you’re at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol .
On this page well go through what HbA1c means, and why aiming for your target level is so important. Well also explain the HbA1c test in more detail, and show you what you can do to lower your HbA1c levels if theyre too high. Plus, you can use our HbA1c converter tool if youre looking to find out your level in % or mmol/mol.
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How To Lower Your A1c Levels
Its important to get your hemoglobin A1C levels as close to normal as possible, says Dr. Bellatoni, Decreasing your hemoglobin A1C decreases your risk of having complications from diabetes. Even if you cannot get your A1C back to the normal range, any improvement lowers your risk of diabetes complications.
Take Advantage Of Tech
There are lots of apps out there to help patients manage their diabetes. What may work for one person may not work for anothertry out a few to find a good fit. You may want to talk to your doctor about getting a continuous glucose monitor to help you track your progress. These tiny sensors, which are inserted under the skin, are a great way to see your glucose levels in real timesome can even send your results to your tablet or smartphone.
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Why Is My A1c High
As blood sugar level rises, so do A1C levels. A high A1C indicates that blood sugar control is not optimal. This in itself is not an emergency, but it gives your healthcare provider a picture of how blood glucose has, or has not, been controlled, says Dr. Williams.
Poor diabetes control or a need for medication adjustments might cause higher A1C. Diet changes, daily exercise, or medication adjustments might quickly lower A1C. Because Type 2 diabetes is a progressive disease, adjustments to ones treatment might be a part of the process of controlling diabetes. Poor diabetes control does not always mean a patient is doing something wrong. But there are other reasons why levels might be high.
As previously mentioned, other health conditions can cause skewed results. These include kidney disease, anemia, liver disease, asplenia, blood loss, hypothyroidism, uremia, and sickle cell anemia. Other factors that might lead to a high A1C level include increased age, pregnancy, and gestational diabetes.
Can Other Blood Glucose Tests Be Used To Diagnose Type 2 Diabetes And Prediabetes
Yes. Health care professionals also use the fasting plasma glucose test and the OGTT to diagnose type 2 diabetes and prediabetes. For these blood glucose tests used to diagnose diabetes, you must fast at least 8 hours before you have your blood drawn. If you have symptoms of diabetes, your doctor may use the random plasma glucose test, which doesnt require fasting. In some cases, health care professionals use the A1C test to help confirm the results of another blood glucose test.
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How The Test Works
The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound.
Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.
If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher.
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Lifestyle Tips To Help Maintain Good A1c Levels
Heres the good news: There are lots of different ways to lower your A1c without medication. Well review some below:
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Change what youre eating: This is a big one. Your A1c will naturally drop if youre able to eat less of certain foods and more of other foods .
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Move your body: Exercise is a great tool to improve your overall health. And it can help to lower your A1c.
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Lose unwanted weight: Weight loss isnt easy. But it can be an effective way to improve the way your body regulates blood glucose levels.
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Find support in your community: Diabetes is common. Chances are that there are people in your community who have faced similar health challenges and can support you in your journey.
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A Closer Look At The Doctors Proposed A1c Guidelines
To make the new recommendations, study authors analyzed past studies and guidelines issued by other organizations from around the world. Beyond making the general recommendation for a new A1C target, the group proposed the following three guidelines:
- Ease up on diabetes treatment for any patient with an A1C of 6.5 or lower, to avoid his or her blood sugar levels from dipping further.
- Individualize management goals based on factors like life expectancy, cost of care, and medication risk.
- Do not set a target A1C level in people who have a life expectancy of less than 10 years due to advanced age , have certain chronic conditions, or are living in a nursing home.
Six coauthors of the report assessed each guideline using a tool that evaluates research materials based on six criteria, including clarity of presentation and a study’s scope and purpose.
While the ACP did not return repeated requests for comment before publication of this story, Jack Ende, MD, president of the ACP who is based in Philadelphia, said in a news release that avoiding treatment in people with an A1C below 6.5 will reduce unnecessary medication harms, burdens, and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy, referencing macrovascular complications.