Practically Active
Experts disagree about the best advice to give diabetics about A1C blood test.
Life is not over because you have diabetes. Make the most of what you have, be grateful. — Dale Evans (1912-2001), actress
A few days ago a Facebook friend posted an article about possible new changes to the standard for Type 2 diabetics’ blood sugar levels. Then a reader emailed an article on the same topic; so it seemed only fitting that I share the information.
The issue involves the A1C measurement. I’ve written about it in past columns, but basically it’s an average of blood sugar levels over a span of about three months. The process is a bit involved, but it gives us, and our doctors, an idea of how well we’ve been controlling our blood sugar levels.
There isn’t a meeting of the minds about new guidelines, folks. From the perspective of a patient who just wants to know what the guidelines are, there seems to be one of those awkward little slap fights going on.
I’m drawing information from the websites of The Diabetic News (thediabeticnews. com), an online article in the Wall Street Journal and an article on the website of National Public Radio (npr.org).
In early March, the American College of Physicians recommended that patients with Type 2 diabetes be treated to achieve an A1C from 7 percent to 8 percent rather than 6.5 percent to 7 percent. Aiming for levels from 7 percent to 8 percent seems to “maximize benefit and minimize burden” for people with diabetes, according to Jack Ende, president of the American College of Physicians and an internist at the University of Pennsylvania.
Thinking back to my diabetic history, my doctors have told me to strive for an A1C below 7. It ain’t easy.
“The reasoning is this,” Ende says. “The burdens of striving for a lower number include a greater risk of low blood sugar, which can cause fainting. Patients taking medication to reach a lower level may face side effects and weight gain.”
The college, a 152,000-member national group of specialists in internal medicine, says studies have found that more aggressive treatment of diabetes didn’t reduce deaths or complications, including heart attacks or stroke.
Ende says the internists believe there’s no harm in patients striving for lower A1C levels if they can reach them through lifestyle changes such as diet and exercise. “It’s the excessive medication that can be problematic.”
The American Association of Clinical Endocrinologists, the American Diabetes Association and other groups were quick to criticize the internists’ new target as too high. They are still in favor of 7 percent or lower.
“The moment your blood glucose goes above normal, it’s incurring damage to the back of the eye, to kidneys and to nerves, especially in the feet,” says Dr. George Grunberger, who was on the committee that drew up diabetes guidelines for the American College of Endocrinologists.
He was stunned to learn that the internists group was giving more weight to the risks of low blood sugar than the benefits of keeping it under control. “My concern is this will be a message to many participating physicians saying, ‘Well, don’t worry about it so much, because it’s OK.’”
“We stand by our guidelines,” says Dr. William Cefalu, chief scientific, medical and mission officer of the American Diabetes Association. He says, for one thing, the higher target gives short shrift to a new generation of drugs that are in use to control blood sugar. Those drugs carry less risk for hypoglycemia (low blood sugar) and some very favorable effects on body weight and other cardiovascular factors.
But everyone seems to agree on one thing — there is no one-size-fits-all solution.
“These are recommendations,” Ende says. “Your doctor should make a decision based upon their best information in each particular case.”
Those of us with diabetes know the struggle of keeping our numbers low. A lot of us don’t like taking the medications or insulin. If we can find an A1C “sweet spot” and manage our glucose levels, we might just be able to stop the meds altogether.
Wouldn’t it be nice.