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(HealthNewsDigest.com) – It is estimated that 30 million Americans have diabetes and over 95% of them have type 2 diabetes. To help your doctor develop the right treatment for your condition, A1C tests are preformed routinely.
A1C is a blood test that provides an evaluation of your blood sugar levels over the last 3 months. The higher the A1C number, the higher your blood sugar has been. Values between 5.7% and 6.4% indicate a risk for prediabetes. At this point you have gotten a wake-up call to pay closer attention to your health, exercise habits, and your weight to prevent the progression to type 2 diabetes. If your A1C is 6.5% or higher you are at risk for diabetes.
How does A1C measure your blood sugar? There is a compound in your blood called glycosylated hemoglobin. Hemoglobin is found inside all red blood cells. When blood sugar is too high there is a build up of glucose in the blood. This extra glucose links up (or glycates) with hemoglobin to form glycosylated hemoglobin. Once cells are glycated, they stay that way. The more sugar in your blood, the higher the percentage of A1C cells you’ll have. Since each glycated cell has a lifespan of about 3 months, measuring the percentage of glycosylated hemoglobin in your blood provides a snapshot of the levels of glucose in the blood over the last few months.
For most people with type 2 diabetes the A1C value should be below 7%. A value of 7% means your average blood sugar has been 150, which is very good. For younger adults with a long life expectancy and no current heart disease, an A1C goal of 6% to 6.5% might be considered. For people who have had type 2 for a long time, have other health issues, and may have a history of many incidences of low blood sugar (hypoglycemia), less strict A1C goals of 7.5% to 8% may be appropriate. The A1C goals should be set individually for each person taking into consideration their age, other health conditions, and how long they have had diabetes.
A1C tests are an excellent tool to tell the patient and their doctor how well they are doing but there is some concern that many patients are being tested too often. Researchers from the Mayo Clinic looked at a nationwide population of over 31,500 nonpregnant adults who controlled their type 2 diabetes without insulin. More than half of all these patients achieved and maintained an A1C of 7% or less and yet, they were tested 3 to 4 times a year. Some patients were tested 5 or more times. Rozalina McCoy, MD, one of the lead researchers said the we live in a culture where we think more is better and both patients and their doctors favor more tests in a desire for comprehensive care.
But, Dr. McCoy disagrees with this approach. She feels that frequent testing in stable patients adds to medical costs and may result in overtreatment with drugs in some patients. She believes that stable patients can be tested less often, perhaps at their annual check and maybe once more during the year.
A recent statement by the American College of Physicians (ACP) published in the Annals of Internal Medicine echoed many of the finding of Dr. McCoy’s group. The ACP guidelines statement said that evidence does not support treatment with drugs to bring A1C targets below 7%. The lower targets did little or anything to reduce deaths from heart disease or stroke. The initial rationale to lower treatment targets, below 7% or below 6.5%, was the belief that more intensive blood sugar control could reduce heart disease over many years of treatment. Yet, in patient populations this benefit was not seen. Dr. Jack Ende, president of ACP said that for most people with type 2 diabetes, achieving and maintaining an A1C between 7% to 8% will best balance long-term health benefits from the harm of low blood sugar, the need for additional medications, and costs.
What does this research mean to you? The treatment of type 2 diabetes needs to be individualized to each person. Diet, lifestyle and weight management should be the cornerstone of treatment to control blood sugar. A1C tests should help provide guidance in care but achieving a specific number may not be in the best interest of every patient.
To help manage diabetes you may want to take a look at one of my books, The Diabetes Counter which has been helping patients, in numerous editions, since 1990.
© NRH Nutrition Consultants, Inc.
Jo-Ann Heslin, MA, RD, CDN is a registered dietitian and the author of 30 books. Available as eBooks from iTunes and Kindle/Amazon:
Diabetes Counter – the most up-to-date information on managing diabetes
Calorie Counter – a weight loss guide that won’t let you down
Protein Counter – put the latest protein recommendations to work for you
Healthy Wholefoods Counter – planet-friendly eating made easy
Complete Food Counter – food counts and nutrition information at your fingertips
Fat and Cholesterol Counter – newest approach to heart-healthy eating
Available in print from Gallery Books:
Most Complete Food Counter, 3rd Ed.
Your Complete Food Counter App: http://itunes.apple.com/us/app/your-complete-food-counter/id444558777?mt=8
For more information on Jo-Ann and her books, go to: www.TheNutritionExperts.com.