A1c – Why you have to try to go Under 7?

Posted on January 4, 2010

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What Causes High A1cs?

* Inaccurate carb counting *

* Insulin doses that are incorrect, misunderstood, or missed entirely *

* Too hard to log all the data *

* Not adapting to spontaneous events *

* Complexity of the challenge *

* Unclear accountability *

Last year was launched a worldwide campaign to increase the awareness on A1c levels, asking all the people with diabetes to strive to get their A1c level Under 7% and those who are already under 7 to spend some of their time to help others to do the same.

Before the DCCT results came out in 1993 there was some small European studies suggesting that the good control delay or prevents diabetic complications, but it was definitively established with the DCCT results. A few years later the British UKPDS study reported in Barcelona (Spain) similar results with type 2 diabetes patients.

The risk of developing diabetic complications increases as the A1c levels are over 7% and that risk skyrockets with A1c levels over 8%.

clinidiabet.com

Relationship between microvascular complications and A1c in type 1 diabetes. Stylized relative risks for development of various complications as a function of mean A1c during follow-up in the DCCT. For the purposes of illustration, the relative risk of various complications is set to 1 at A1c of 6%. The lines depict a stylized relationship for risk of: (A) sustained progression of retinopathy , (B) progression to clinical nephropathy (urinary albumin excretion > 300 mg/24 hrs), (C) progression to severe non-proliferative or proliferative retinopathy, (D) progression to clinical neuropathy, and (E) progression to microalbuminuria (urinary albumin excretion > 40 mg/24 hrs). Adapted from: Skyler JS: Diabetic Complications: Glucose Control Is Important. Endocrinology and Metabolism Clinics of North America 1996; 25:243-254.

Summary of American Diabetes Association Recommendations for Adults with Diabetes

Glycemic control

  1. A1C <7.0%* for patients in general
  2. A1C <6.0% (as close to normal as possible without significant hypoglycemia) for the individual patient
  3. Preprandial capillary plasma glucose 90–130 mg/dl
  4. Peak postprandial capillary plasma glucose (1-2 h after the beginning of the meal) <180 mg/dl
Blood pressure

  1. <130/80 mmHg
Lipids

  1. LDL <100 mg/dl (ideally <70 mg/dl)
  2. Triglycerides <150 mg/dl
  3. HDL >40 mg/dl in men, >50 mg/dl in women
*Referenced to a nondiabetic range of 4.0–6.0% using a DCCT-based assay.

endotext.org/diabetes


Posted in: complicatii