by Stephen Freed, R.Ph., Diabetes Educator
Publisher, www.DiabetesInControl.com
The Centers for Disease Control and Prevention (CDC) has stated that children born in the year 2000 and after have a one in three chance of getting diabetes and if African American, Hispanic American or Native American, every other child will eventually develop Type 2 diabetes.1
Now, for the first time, there is a test that can be done in the privacy of a patient's home to find out what their risk factor is for developing diabetes. And – if they already have diabetes2 – home A1c testing products can determine what their risk factor is for complications and even help to monitor how they are managing their diabetes. This test – available for home use – is a 90 day average of blood sugars.
In my practice, I tell my patients that the A1c number can determine your "Quality of Life." My goal is to reduce that number to as close as possible to a normal A1c, as if they did not have diabetes, thus improving their quality of life.
The American Diabetes Association says that A1c should be 7.2% or below, and the American Endocrinologists Association says it should be 6.5% or below. In reality, most doctors stop treating their patients if their A1c is 6.5 to 6%. (And we know that diabetes is a progressive disease and as we get older and slow down, that number will go up.)
In the EPIC-Norfolk study3, when researchers compared A1c results for thousands of patients, irregardless of whether they had diabetes or not, they found that when they compared those people with an A1c of 6%, to those with 5%, the people with an A1c of 6% had an increase in cardiovascular death of 28% for women and a 26% increase for men. So why do most doctors stop being aggressive with their treatments when a person has a 6-6.5% A1c?
The goal should be to get the A1c down to as close to "normal" without causing hypoglycemia. And ultimately, once they know exactly what the risk factors are, it should be up to the patient, working with their diabetes team, to determine their A1c goal.
Ask your patients: Do You Know Your Quality of Life Number?
1. CDC: www.cdc.gov One in three children born 2000 and above will develop diabetes.
2. American Diabetes Association: www.diabetes.org. ADA recommendations for A1c.
3. EPIC-Norfolk (2001) Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk) BMJ 2001;322:15.
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