How well does A1C reflect diabetes control?

DEAR DR. ROACH»

In one of your recent columns a writer had Type 2 diabetes with an A1C level usually no higher than 6.2% controlled with oral medication.

You said that level is so well-controlled that you wondered if the person needed the medication, and that many experts would reduce or eliminate medication in a 66-year-old with that A1C.

Wouldn’t it be the medication that is keeping the A1C no higher than 6.2%? I am 66, and my last A1C was 5.2%. Three years ago, it was 8.2% on metformin, so my doctor added a second oral medication. It has been no higher than 6.5% ever since. Are you suggesting I may no longer need these oral medications?

— A.l.

ANSWER» A well-done but sometimes misinterpreted study showed that among people at higher risk for heart disease, a goal of keeping the A1C below 6% led to worsening heart disease and greater risk of death than when the goal was 7%.

Most 66-year-olds with diabetes are at high enough risk that experts would not use additional medication in someone already below 7%.

The exact goal number for A1C remains controversial, with experts sharply divided, but guidelines with a goal A1C of less than 8% have been proposed for older patients and those with other medical conditions that limit life expectancy, or a history of severe low blood sugars.

You are absolutely right that stopping all medication is likely to bring a person’s A1C level to what it was before medication — unless the person has already made significant changes in weight, diet, exercise or a combination of these.

People should not stop all medications immediately, but rather try cautiously cutting down the dose of medication and observe the effect on the A1C. There will be some people in whom medications may be stopped altogether.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.

Keith Roach