My 21 year old son recently had an A1c of 6.9%. His doctor says that’s fine, but my son wonders if it could be better. He’s switched to a new doctor who might not be as rigorous about control as his past doctors were.

It sounds like your son is very engaged in his diabetes care, and that is to be commended. Hemoglobin A1c is just a piece of the complex puzzle of managing diabetes, an important piece, but not the only piece. A result of 6.9% sounds wonderful if the normal range is less than 5.9%. The famous DCCT study on type 1 diabetes showed good long term outcomes with a hemoglobin A1c less than 1% above the top of the normal range. In the DCCT, the normal range was 4-6%, and the results were best when the results was 7% or less. However, the result alone isn’t everything.

How is your son doing overall? Does he have many low blood sugars daily, weekly? If he has more than one low blood sugar a week, he may be sacrificing quality of life for a good hemoglobin A1c result. This lab result shows the “average” blood sugar. That could mean a lot of highs and lows which average to a “good” number. This is why the hemoglobin A1c result is a piece of the puzzle. If he finds that he rarely has a low blood sugar, and he is able to enjoy a good quality of life and his hemoglobin A1c is within the target, that is wonderful. If the only thing good is his hemoglobin A1c and he’s scrambling to stay above a low blood sugar, this needs further investigation.

KS