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A1c<7

By David Mendosa

Last Modified On: December 2, 2002

If you didn't notice that November 14 was World Diabetes Day, you didn't miss the big party. We aren't celebrating a cure for the disease yet. But on that auspicious day more than two dozen organizations got together to focus on the most important measure of control.

Why not shoot for 6.2?

They launched a national educational campaign to help us reduce the complications of diabetes. How? By improving our average blood glucose level to less than 7 as measured by the A1c test. This blood test lets us look back over the past two months to see how we have been doing.

And we haven't been doing very well at all. The average American with diabetes probably has an A1c between 8.5 and 9. That's what Nathaniel Clark, M.D., the American Diabetes Association's national vice president of clinical affairs told me a few days ago. He represented the ADA at the press conference that kicked off the Diabetes A1c Initiative.

The ADA's goal is for us to reach a level below 7. The new initiative has the same goal.

The normal range for people who don't have diabetes is 4.5 to 6.2, according to the UK Prospective Diabetes Study. The UKPDS was the biggest and longest study of people with type 2 diabetes ever, a 20-year trial with about 5,000 participants. It is when our levels go above 6.2 that we start getting complications, the UKPDS says.

Then why not shoot for 6.2?

"There is evidence that as you get below 7 you continue to get a reduction in the rate of complications," Dr. Clark tells me. "But the relationship—the cost-benefit ratio—as you get below those numbers becomes less and less favorable. For example, if you had an A1c of 9 and you reduced it to 8, you would get a benefit. And that benefit would be substantially greater than if you were at 8 and you moved it to 7. As you get below 7 the curve really flattens out. In some patients you get more hypoglycemia and in other patients you may need insulin or another drug or have to make other changes."

The lead sponsor of the Diabetes A1c Initiative pushing us to get our average level down to 7 is Aventis Pharmaceuticals. That name may be familiar because Aventis makes a very long acting insulin called Lantus (insulin glargine) and two sulfonylureas, Amaryl (glimepiride) and Diaßeta (glyburide). The company's Web site in support of the initiative is http://www.diabeteswatch.com/a1c/.

No doubt there's something in the initiative for Aventis to make its investment worth while. Even more certain is the fact that those of us with diabetes will benefit even more by using insulin and oral medications made by Aventis and other companies.

That's why three major partners have committed staff and time to work on putting out the word. They are the American Association of Diabetes Educators, the International Diabetes Center in Minneapolis, and Take Control of Your Diabetes.

It seems to me that one recent technological advance that will help us test more often and bring down our levels is the advent of home A1c meters and test kits. I describe and link three new meters and five test kits in the section on "A1c Meters and Kits" on my On-line Diabetes Resources Part 14: Blood Glucose Meters Web page.

I asked Richard Bergenstal, M.D., executive director of the International Diabetes Center, if he shared my enthusiasm for these devices. Dr. Bergenstal is also an endocrinologist at Park Nicollet Health Services in Minneapolis.

"I like the concept of point of care or portable tests," he replied. "Anything that helps patients have their A1c before seeing healthcare providers is very helpful. There are good studies now showing having the A1c in hand at the time of a visit changed the management plan and helped move closer to the A1c goal than standard lab testing."

Specifically, Dr. Bergenstal thinks the Metrika A1cNow meter has great promise. "I have tested the Metrika device and find it very acceptable," he told me. "It can now be purchased in a pharmacy with at prescription and done at home by the patient. It is currently pending over the counter approval."

Jane Kadohiro, president of the American Association of Diabetes Educators, summarizes what the initiative is about. "The whole campaign is aim, believe, achieve," she says. "What we mean by that is aim for less than 7, believe it is possible for you to do it, and achieve the goal of less than 7."

We now have widespread acceptance of the importance of the A1c and agreement on the target of less than 7. That clear goal finally gives us good reason to hope for better control and many fewer complications.


The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.


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