Wednesday, April 2, 2008

Hemoglobin A1C: How Low to Go?

Being a person with diabetes is hard work. Being a physician is hard work. I don't doubt that being a journalist is hard work too, especially with the focus on reporting what is particularly sensational. Good news, from a medical standpoint, is often just not very eyecatching.

What does seem to get a lot of press attention is reporting about research studies that are not completed. There have been efforts by the editors of medical journals requesting medical reporters and medical researchers to hold off until the research is complete and has at least undergone some initial analysis. Perhaps few people of any profession can resist the media spotlight.

As an example, interim findings reported in February from the ADVANCE diabetes trial did not show evidence of an increase in deaths of those persons in the "arm" of this study that worked to achieve a hemoglobin A1C of 6.5 or less (compared to those in the control arm who aimed for a HbA1C of 7.0 to 7.9). These findings were released in response to news from the ACCCORD diabetes trial which did show a higher mortality rate in those in that study's aggressive treatment group, who also aimed for a HbA1C of 6.5 or less.

The advice of the American Diabetes Association in response to both news stories is for persons with diabetes to NOT change their treatment regimens based on these preliminary findings as there is "insufficient evidence from what we've heard so far".

Very good advice. It is an admirable practice for persons with diabetes and the doctors who treat them to keep up with the latest information on diabetes treatment but very unwise to set one's course based on today's news stories or tomorrow's. Right now, aiming for a HbA1C between 6.5 and 7.0 is a sensible and solid course for which to aim.


Anne said...

I have to comment. The ACCORD study tried to lower blood sugar in an population who either had heart disease or were at high risk for heart disease. I am sure the diet recommended during this study was the ADA diet full of carbs that were sure to raise BG levels. The more carbs eaten, the higher the BG levels, the more medications used. What would have happened if they study patients had been put on a lower carb diet and lower doses of medications. If I ate the typical diet recommended by the ADA, my blood glucose would be way too high.

When the ACCORD study was stopped, the data of ADVANCE study was reviewed. This was a similar, large, multinational study. It was determined that there was no excess risk to the participants who were in the intensive glucose lowering arm. Why did this not make headlines?

One of the best sites I have come accross about diabetes is Blood Sugar 101

Bernard said...

It's important to know that the group involved in this study had the issues pointed out by Anne and type 2 diabetes.

Many of us with type 1 diabetes are annoyed by the bad press that fails to distinguish between these two very different diseases.

I still don't understand why one group was aiming for so low an A1C. Why not 7.0 or less? That's aggressive but not to the same extent.

It seems to me that the recommended A1C values are primarily aimed at folks with type 2. That makes sense, since they make up 90% of the population with diabetes.

Achieving a level of 7.0% is extremely challenging for someone with type 1 diabetes. When will the ADA come to it's sense on this?

Anne said...

An A1C of 7% is equal to an average blood glucose of 135. Is that really acceptable? Are you saying that a higher A1C is OK?