January 7, 2009
A1c (Glycohemoglobin, HgbA1c)
Question from Georgia, USA:
My son has MODY 2, diagnosed through genetic testing this past August. I have written before and have been advised here that his A1c average of 6.6 is too high. I agree with this. However, I have been to two pediatric endocrinologists affiliated with a very respectable hospital (Emory) and both of them have said that with a 6.6 A1c and MODY 2, diet and exercise is all we will do. One of these doctors called another doctor in Florida to double check and he also agreed. I have been in contact with Dr. Fajans who discovered MODY and he agrees with this and says only 2% of MODY 2 patients have complications. I respect his knowledge and appreciate his advice. After all of this, I should be comfortable, but I am still worried. I have read that an A1c of higher than 5.0 can cause heart trouble in the population as a whole, not just diabetics. My son’s great grandfather, who we believe probably was also a MODY 2, lived to be 86. At some point, he was on insulin, then just oral medications, than just diet and exercise. I imagine they kept changing his medication because of the way he was presenting but did not know about MODY back then. He was thin his whole life. I don’t know how long he was on each medication or diet and exercise because he has been deceased for 20 years. I can’t help but wonder if the insulin and oral medication in his younger years didn’t help prolong his life, which was a very healthy life with no complications. I don’t know where to turn now since four doctors have said this is the best route. He is testing one day a month to make sure he is still on track and will be getting an A1c every six months through a blood draw. My son is thin and active. Should I just stop worrying?
Answer:
You ask very complicated and difficult questions to which science does not have very exact answers, I am afraid. You are also getting some conflicting advice as a result. I would agree with your conclusions that lower A1c levels are significantly better for long term health outcomes. The key question is how to achieve such lower A1c results with MODY. If your child were not obese, then more vigorous daily exercise would help lower the blood glucose excursions and thus the A1c levels. Lower carbohydrate intake would likely also do the same. So, you may experiment a bit using pre- and postprandial glucose readings done at home as your main guide and see if this could also translate into lowered A1c levels. We would usually recommend A1c levels every three or four months, not every six months but, here again, this is individual preference. If you want to have a “tighter” control goal, then you would need more home monitoring and also more A1c
SB
