April 15, 2004
A1c (Glycohemoglobin, HgbA1c)
Question from Lynnwood, Washington, USA:
I’ve had type 1 for a little over two years and all of my subsequent A1cs have been under 6.5 percent. I know this is doing quite well, as the goal is 7 percent or less according to my endocrinologist and the Diabetes Complications and Control Trial. Although it’s quite difficult and restrictive, the thought of complications frightens me too much to not do everything I can to maintain this level of control. The type 2s I know think my A1c is so high compared to their numbers, which are 4.9 or 5.2. I keep telling them that, as far as I know, for someone on insulin, my A1c’s have been excellent. I read so often of others with consistent A1c’s in the 8 or higher range that I am left to wonder what is really typical. I’d like to know your opinions and experience of what the average type 1 realistically achieves under normal circumstances. Are the majority of us sitting in the under 7 percent range or are we more the exception than the rule? It’s hard to really know how you’re doing when you have nothing to compare your results to.
Answer:
Until a approximately three years ago, the average A1c among Americans was still over 9 percent. This is a poor grade for our national effort at treating diabetes. However, I would suspect that number has come down. Diabetes is a social issue many are more familiar with now. With that comes more knowledge about what treatment goals should be. Diabetes specialists see less than twenty per cent of all the patients who see patients with diabetes. Most of the patients with diabetes have type 2 diabetes. The market and current practice environment is that all primary care physicians have an ability to treat patients to an acceptable A1c level.
A second issue is worth mentioning. It has been written that normal A1c values are more easily attainable in patients with type 2 diabetes, compared with type 1 diabetes. In general, I agree with this statement. With type 1 diabetes, hypoglycemia becomes a limiting issue in terms of how low you can go. This is less an issue with type 2 diabetes, especially if they are on oral medications.
JTL
