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How aggressive should we be with HbA1c?

Updated: Mar 18, 2020

HbA1c target guidelines vary vastly worldwide. Most recommendations range from <6.5% (AACE) to <7.0% (ADA).’ Though there is a vast amount of research proving a correlation between elevated HbA1c (>7.0%) and complication risk, few studies have been done to justify a more aggressive target of <6.5%. We all know that an HbA1c value of <6.5% requires substantial effort. People often get frustrated, burnt out, and the risk of hypoglycemia increases significantly. So, is it worth it? Dr. Marcus Lind sought to answer this question in a study recently published in the BMJ where he compared the incidence of diabetic retinopathy and nephropathy in people with HbA1c’s measuring 6.5-6.9% to those measuring <6.5%. The study consisted of >10,000 subjects over a span of 20 years. Though they found a significantly increased risk of complications in people with HbA1c > 8.6% and a mildly increased complication risk in the >7.0% group, the study showed no significant difference in complication risk between the 6.5-6.9% and the <6.5% group. There was, however, a significantly higher rate of hypoglycemia in the HbA1c <6.5% cohort. What do you all think of this? For reference, an HBA1c of 6.5% is equivalent to an average blood glucose of 139mg/d. More studies are clearly needed, but the results of this study truly highlight the importance of using HbA1c as an ADJUNCTIVE measure of success in diabetes in addition time in range, time spent in hypoglycemia, glucose variability, and let’s not forget my favorite measurement of success; quality of life! Please post your thoughts below!

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