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What Is A Good A1c For A Type 2 Diabetes?

The Normal A1c Level

The Normal A1c Level

You want to control your diabetes as much as possible. You wouldn’t be reading this if you didn’t. So you regularly check your A1C level. This is the best measurement of our blood glucose control that we have now. It tells us what percentage of our hemoglobin – the protein in our red blood cells that carry oxygen – has glucose sticking to it. The less glucose that remains in our bloodstream rather than going to work in the cells that need it the better we feel now and the better our health will continue to be. Less glucose in the bloodstream over time leads to lower A1C values. As we are able to control our diabetes better and better, the reasonable goal is to bring our A1C levels down to normal – the A1C level that people who don’t have diabetes have. But before we can even set that goal, we have to know what the target is. The trouble with setting that target is that different experts tell us that quite different A1C levels are “normal.” They tell us that different levels are normal – but I have never heard of actual studies of normal A1C levels among people without diabetes – until now. The major laboratories that test our levels often say that the normal range is 4.0 to 6.0. They base that range on an old standard chemistry text, Tietz Fundamentals of Clinical Chemistry. The Diabetes Control and Complications Trial or DCCT, one of the two largest and most important studies of people with diabetes, said that 6.0 was a normal level. But the other key study, the United Kingdom Prospective Diabetes Study or UKPDS, which compared conventional and intensive therapy in more than 5,000 newly diagnosed people with type 2 diabetes, said that 6.2 is the normal level. Those levels, while unsubstantiated, are close. But then comes along one of my heroes, Dr. Continue reading >>

Editorials: Controversies In Family Medicine

Editorials: Controversies In Family Medicine

KEVIN PETERSON, MD, MPH, FRCS, FAAFP, University of Minnesota Medical School, Minneapolis, Minnesota Am Fam Physician. 2012 Dec 15;86(12):online. Related editorial: Should the Target A1C Level Be Less Than 7 Percent? No: The Case for Modest Glycemic Control in Patients with Type 2 Diabetes. This is one in a series of pro/con editorials discussing controversial issues in family medicine. In 1993, the DCCT (Diabetes Control and Complications Trial) demonstrated that better glycemic control reduces microvascular disease in patients with type 1 diabetes mellitus.1 Ten years later, the EDIC (Epidemiology of Diabetes Interventions and Complications) trial established that macrovascular disease was also reduced by the DCCT.2 In 1998, the UKPDS (United Kingdom Prospective Diabetes Study) demonstrated that intensive glycemic control also reduces microvascular disease in patients with type 2 diabetes, but that macrovascular disease reduction is only a statistical trend.3 Although these landmark studies provided the basis for establishing recommended A1C targets, subsequent guidelines often used optimistic interpretations of the evidence.4 In 1999, the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial began to evaluate whether a normal A1C level (less than 6 percent) provided better macrovascular protection than was obtained by intensively treated patients in the UKPDS (7.5 percent).5 The ACCORD trial identified 10,251 patients with type 2 diabetes and existing cardiovascular disease to ensure high cardiovascular event rates. By 2010, the trial demonstrated in 65-year-old patients with preexisting cardiovascular disease that lowering A1C levels to less than 6 percent resulted in higher mortality rates and no reduction in the primary composite outcome (cardiovascular Continue reading >>

Why I'm Motivated To Maintain A 6.0 A1c With Type 1 Diabetes

Why I'm Motivated To Maintain A 6.0 A1c With Type 1 Diabetes

At the age of 13, I was diagnosed with type 1 diabetes (I also have Celiac disease). Somewhere in my 20s—motivated by the promise of better health now, and in the long run—I started making changes to maintain a 6.0 A1C level. I have to admit, maintaining this number wasn’t easy at first. So why go to such lengths to maintain an A1C of 6.0 when the American Diabetes Association says an A1C of 7 or less is desirable for people with type 1 and type diabetes? And the recommendation from the American Association of Clinical Endocrinologist (AACE) is less than 6.5? That’s easy: I slept better, had fewer blood sugar highs and lows, required less insulin and felt much more energetic. When your blood sugars are running in the mid-to-high 100s every day (an A1C of 7) you might not realize just how sluggish you feel until you get them down. High blood sugars take HOURS to get back into range so if you’re working to prevent them from happening in the first place, you’re staving off a lot of stress on your body. I also discovered that high blood sugars during sleep interfered with me getting truly restful sleep. I also felt my muscles’ ability to perform during exercise was worse. The list goes on and on. Without becoming obsessive about my diabetes management, I’ve actually been able to maintain an average blood sugar of 125 mg/dL and an overall range of 100 to 152 mg/dL most of the time. Periodic testing of A1C levels, which cannot be done at home, is important. Research shows that being in a healthy blood sugar range correlates with fewer complications from diabetes, such as kidney disease, diabetic neuropathy and high blood pressure later in life. In other words, better diabetes control translates into better health. If you wind up having a high A1C level it may Continue reading >>

About Type 2 Diabetes And High Cholesterol

About Type 2 Diabetes And High Cholesterol

WELCHOL is not for those with blood triglyceride levels of > 500 mg/dL Type 2 diabetes is the more common form of diabetes1 95% of people with diabetes have type 2 diabetes2,3 More than 90% of people with type 2 diabetes are overweight or obese3 Type 2 diabetes is often associated with obesity, family history, and physical inactivity.3 Common symptoms of diabetes may include urinating often, feeling very thirsty, feeling very hungry (even though you are eating), extreme fatigue, blurry vision, cuts/bruises that are slow to heal, and tingling, pain, or numbness in the hands and/or feet (type 2). However, some people with type 2 diabetes may not experience any symptoms.4 Type 2 diabetes in adults is a chronic condition that should be taken seriously Type 2 diabetes can be associated with many serious health complications including5: Neuropathy (tingling, pain, numbness, or weakness in the feet and/or hands) Kidney disease Eye complications Skin complications High blood pressure Stroke Welchol has not been shown to prevent heart disease, heart attacks, stroke, or any of the above risks. Please see "What is Welchol® (colesevelam HCl)" and "Important Safety Information about Welchol" below. The American Diabetes Association (ADA) explains that type 2 diabetes is a problem with the body that causes blood sugar levels to be high, either because the body doesn't make enough of the insulin hormone, or the body does not use insulin properly. When your body does not use insulin properly, this is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time your pancreas isn’t able to keep up and can’t make enough insulin to keep your blood sugar levels normal. Type 2 diabetes is treated with lifestyle changes (healthy eating and exerc Continue reading >>

Diabetes, Type 2

Diabetes, Type 2

What is type 2 diabetes? Also called adult-onset diabetes, type 2 diabetes is a metabolic disorder resulting from the body’s inability to properly use or ultimately make enough insulin, the hormone that helps regulate sugar, starches and other foods the body uses for energy. It is the most common form of diabetes, accounting for 90 to 95 percent of all cases. Type 2 diabetes is nearing epidemic proportions in the United States as a result of a greater prevalence of obesity and sedentary lifestyles. The upswing is also due to the increasing number of older people in the population. What are the symptoms? Many symptoms of diabetes such as excessive thirst or irritability, can seem unimportant, which is one of the reasons why the disease often goes undiagnosed. However, early detection is very important because it can reduce the odds of developing the dangerous complications of diabetes. Common symptoms include: Frequent urination Excessive thirst Extreme hunger Unusual weight loss Increased fatigue Irritability Blurry vision If high blood sugar levels are not brought under control via treatment type 2 diabetes (and type 1 diabetes as well) can lead to a number of serious complications: Eye damage: People with diabetes have a 40 percent higher than normal risk of developing glaucoma, increased pressure within the eye that can lead to vision loss. They are also 60 percent more likely than normal to develop cataracts, which cloud the lens of the eye, blocking light and blurring vision. They are also at risk of diabetic retinopathy, damage to the retina that is the leading cause of impaired vision in the United States. High blood pressure: This disorder occurs at twice the normal rate among diabetics. Heart disease: Deaths from heart disease among diabetics are two to four Continue reading >>

Hemoglobin A1c Test (hba1c, A1c, Hb1c)

Hemoglobin A1c Test (hba1c, A1c, Hb1c)

Hemoglobin A1c definition and facts Hemoglobin A1c is a protein on the surface of red blood cells that sugar molecules stick to, usually for the life of the red blood cell (about three months). The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells. Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time period. Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes. Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%. Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control. Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c. To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives us an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which gl Continue reading >>

How To Lower Your A1c Levels: A Healthful Guide

How To Lower Your A1c Levels: A Healthful Guide

An A1C blood test measures average blood sugar levels over the past 2 to 3 months. The American Diabetes Association (ADA) recommend the use of A1C tests to help diagnose cases of prediabetes, type 1, and type 2 diabetes. A1C tests are also used to monitor diabetes treatment plans. What is an A1C test? An A1C test measures how well the body is maintaining blood glucose levels. To do this, an A1C test averages the percentage of sugar-bound hemoglobin in a blood sample. When glucose enters the blood, it binds to a red blood cell protein called hemoglobin. The higher blood glucose levels are, the more hemoglobin is bound. Red blood cells live for around 4 months, so A1C results reflect long-term blood glucose levels. A1C tests are done using blood obtained by a finger prick or blood draw. Physicians will usually repeat A1C tests before diagnosing diabetes. Initial A1C tests help physicians work out an individual's baseline A1C level for later comparison. How often A1C tests are required after diagnosis varies depending on the type of diabetes and management factors. Lowering A1C levels Many studies have shown that lowering A1C levels can help reduce the risk or intensity of diabetes complications. With type 1 diabetes, more controlled blood glucose levels are associated with reduced rates of disease progression. With type 2 diabetes, more controlled A1C levels have also been shown to reduce symptoms affecting the small arteries and nerves in the body. This influences eyesight and pain while decreasing complications. Long-term studies have also shown that early and intensive blood glucose control can reduce cardiovascular complications in people with type 1 or 2 diabetes. Even small changes in A1C levels can have big effects. The ADA recommend that maintaining fair control Continue reading >>

Setting Appropriate A1c Goals For Patients With Type 2 Diabetes

Setting Appropriate A1c Goals For Patients With Type 2 Diabetes

Reviewed by Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendations—and associated management philosophy—to which the treating clinician adheres. According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2 The ADA suggests that physicians may lower the A1C target to 6.5% for some individuals with short duration of diabetes, a long life expectancy, and no significant cardiovascular disease if the target can be achieved without significant adverse effects of therapy, most notably hypoglycemia.2 Conversely, the ADA suggests a target A1C of closer to 8.0% for individuals with any of the following: history of severe hypoglycemia limited life expectancy advanced microvascular or macrovascular complications multiple comorbidities The higher target A1C is also recommended for patients for whom long-term management of diabetes with behavior modification, SMBG, and glucose-lowering therapy has not helped attain a lower target goal.1,2 These ADA recommendations are partly based on studi Continue reading >>

Hemoglobin A1c (hba1c) Test For Diabetes

Hemoglobin A1c (hba1c) Test For Diabetes

The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It's also called HbA1c, glycated hemoglobin test, and glycohemoglobin. People who have diabetes need this test regularly to see if their levels are staying within range. It can tell if you need to adjust your diabetes medicines. The A1c test is also used to diagnose diabetes. Hemoglobin is a protein found in red blood cells. It gives blood its red color, and it’s job is to carry oxygen throughout your body. The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound. Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months. If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher. For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher change of getting of diabetes. Levels of 6.5% or higher mean you have diabetes. The target A1c level for people with diabetes is usually less than 7%. The higher the hemoglobin A1c, the higher your risk of having complications related to diabetes. A combination of diet, exercise, and medication can bring your levels down. People with diabetes should have an A1c test every 3 months to make sure their blood sugar is in their target range. If your diabetes is under good control, you may be able to wait longer between the blood tests. But experts recommend checking at least two times a year. People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can Continue reading >>

Type 2 Diabetes: A Focus On A1c

Type 2 Diabetes: A Focus On A1c

An interview with Sam Engel, M.D., associate vice president of cardiometabolic and women’s health at Merck Research Laboratories Type 2 diabetes is a chronic, progressive disease characterized by the presence of abnormally high blood sugar levels. It develops due to both genetics and lifestyle choices, and occurs as a result of the body being unable to make and/or use insulin effectively. Today, nearly 30 million people in the U.S. are living with diabetes, and 90-95% have type 2 diabetes. The disease is so prevalent that chances are you know someone who has diabetes. Moreover, if current trends continue, it is estimated that about one in three American adults could have diabetes by 2050. A1C, a measure of the average level of blood sugar over the past two to three months, helps you and your doctor see how well your diabetes treatment plan is working. The recommended A1C goal for many adults with type 2 diabetes is less than 7%; however, this may vary depending on the individual. High blood sugar levels over time can put people with diabetes at risk of many serious health problems, such as heart disease, stroke, kidney disease, blindness and nerve problems. That’s why it is important for people living with diabetes to work with their doctor to set individualized goals and develop a personalized diabetes management plan to manage the ABCs of diabetes: A for A1C, B for blood pressure and C for cholesterol. Helping patients with type 2 diabetes achieve blood sugar control is fundamental. However, having worked in clinical practice for over two decades, I know first-hand how challenging it can be for some patients to achieve blood sugar control. In fact, about one-third of adults with type 2 diabetes are not at their A1C goal, so we have work to do. What other aspects o Continue reading >>

Diagnosing Type 2 Diabetes In Children

Diagnosing Type 2 Diabetes In Children

Doctors at Hassenfeld Children’s Hospital at NYU Langone have extensive experience diagnosing type 2 diabetes in children. This chronic condition is characterized by excess blood sugar. After you eat, the body breaks down sugars and starches into glucose, the main source of energy for cells. When glucose enters the bloodstream, the pancreas releases a hormone called insulin, which signals the liver, muscles, and fat cells to remove the glucose from the blood and store it until the body needs energy. If the body becomes less responsive to the effects of insulin—a condition known as insulin resistance—the pancreas compensates and produces more insulin. With insulin resistance, the body has difficulty absorbing sugar from the bloodstream, leading to an increase in blood sugar levels, a condition known as prediabetes. Type 2 diabetes occurs when the body stops responding to the insulin signal and the pancreas can no longer make enough insulin to compensate for rising blood sugar levels. Causes and Risk Factors Once referred to as adult-onset diabetes, type 2 diabetes has become increasingly common during childhood and adolescence. This trend appears to be linked to an increase in obesity and sedentary habits among children and teens. Although the exact cause of insulin resistance is not completely understood, evidence suggests that being overweight plays an important role. This is because fat cells—especially those found in the abdomen—produce hormones and other substances that increase inflammation in the body, which can lead to insulin resistance. Being inactive, which can contribute to weight gain and lower muscle mass, may be another cause of insulin resistance. Girls with a hormone condition called polycystic ovary syndrome—which can cause facial hair and t Continue reading >>

5 Ways To Lower Your A1c

5 Ways To Lower Your A1c

For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>

The A1c Test & Diabetes

The A1c Test & Diabetes

What is the A1C test? The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research. How does the A1C test work? The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent. Can the A1C test be used to diagnose type 2 diabetes and prediabetes? Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes.1 Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes. Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis. Why should a person be tested for diabetes? Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and li Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — The prevalence of type 2 diabetes continues to increase steadily as more people live longer and grow heavier. Older adults with diabetes are at risk of developing a similar spectrum of macrovascular and microvascular complications as their younger counterparts with diabetes. In addition, they are at high risk for polypharmacy, functional disabilities, and common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain [1]. This topic will review diabetes management in older patients and how management priorities and treatment choices may differ between older and younger patients. The general management of type 2 diabetes is reviewed separately. (See "Overview of medical care in adults with diabetes mellitus" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) TREATMENT GOALS — The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy or frail with many como Continue reading >>

Why Raise Your A1c?

Why Raise Your A1c?

Have you been ordered by your doctor to get your A1C (HbA1c) level up? More people are having this confusing experience, as doctors try to implement the 2013 ADA treatment guidelines. Do these orders make sense? Not much, I’d say. What is happening here? In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) changed the targets doctors should aim for in treating diabetes. They went from a one-size-fits-all target of 7.0% HbA1c to a three-tiered guideline. HbA1c is the test that gives an idea of the average blood glucose level for the previous two months or so. An A1C of 7.0% equals an average blood glucose of around 154 mg/dl, and many people think that number is too high to protect against complications. So there was pressure to lower the guideline. At the same time, many older people found the 7.0% goal too strict. A few studies found an increased risk of falls in older people who run low glucose levels. There was concern about increased risk of hypoglycemia (low blood glucose). As Diane Fennell wrote here, many think that aiming for lower A1C levels leads to an increase in low blood glucose episodes. As many readers commented, hypos are dangerous and unpleasant. For many, they are the worst fact of life with diabetes. So the experts finally recognized that one size does not fit all. Unfortunately, their new guidelines have been misunderstood by some doctors, leading to people being told to raise their A1C numbers, even if doing so increases their complication risk. According to the new guidelines, older or sicker people, or those with many hypoglycemic episodes, might shoot for 7.5% to 8.0%. Younger, healthier, people might want to get their A1C below 6.5%, or even lower. People in between on age and health mi Continue reading >>

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