February 23, 2006
A1c (Glycohemoglobin, HgbA1c), LADA and MODY
Question from Oxford, England:
I am 21 year old female with MODY 3 diabetes (confirmed by DNA testing) for just over six years. I am currently treated with gliclazide, 40mg, once daily in the morning.
I recently had an A1c done on December 15, 2005 which was 6.5%. I then had another prior to my appointment with my diabetes consultant on February 2, 2006, which was 7%. To me, this seemed like a bit of an increase in a small period of time.
My home meter readings have been higher than I would like, with fasting blood glucoses between 5.5 and 10 mmol/L [99 and 180 mg/dl]. My pre-evening meal glucose ranges from 7 to 20 mmol/L [126 to 360 mg/dl] and my bedtime glucoses, which are at least two hours after my last meal, range from 12 to 23 mmol/L [216 to 414 mg/dl].
At the higher blood glucoses, I feel symptomatic. I also feel drained and heavy legged when attempting to play badminton in the evening when my glucose is 15 mmol/L [270 mg/dl] or above.
My consultant was unconcerned with home readings since my A1c was only 7% and that’s what he bases any treatment decisions on. Do you think that an increase in 0.5% over a six week period is a big increase or not? Do you think that a medication review with the possibility of increasing the gliclazide would be appropriate to lower the high evening readings? Or, am I worrying about nothing as an A1c of 7% actually shows good control?
Answer:
I do not think that it is trivial. On the other hand, you might be able to alter your lifestyle so that diet and exercise are better. If the results remain over 7%, I think that is clearly enough information to intensify therapy. Treatment algorithms are used for diabetes and many indicate that the goal for the A1c is less than 7%. However, there is no safe level of glucose and therapy should be directed at normalization of the A1c, unless hypoglycemia intervenes. Your doctor may choose to use this information such that if the A1c stays up above 7% over a prolonged time, he may intensify therapy. Because your dose of the oral agent is near the maximum, you would have to consider another agent to add to it.
JTL
