ASK THE DOCTOR Experts divided on exact A1C goal

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 wellcontrolled that you wondered if the person needed the medication. Wouldn’t it be the medication that is keeping the A1C no higher than 6.2%?

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.

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 and exercise.

Dear Dr. Roach:I am a 66-year-old man. I have been running for over 25 years. My problem is that just after my retirement (past June) I developed neuropathy in my feet.

I have seen my family doctor. He recommended I take vitamin B12 daily, go to acupuncture therapy weekly and use topical lotions daily. The pain has gotten worse.

H.M.

Answer: Runners are more likely to develop mild numbness from repeated trauma that damages the nerves, but seldom does it cause pain. There are many causes of neuropathy. Diabetes is probably the most common when presenting on both feet, but B12 deficiency is another. For that, I recommend checking the B12 level rather than taking supplements based on an educated guess. There are many other causes.

If no cause can be found, treatment for painful neuropathy may still be effective. Gabapentin (Neurontin) is one treatment, but there are more.

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