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Harvard Health Blog
Rethinking A1c goals for type 2 diabetes
- Author: Monique Tello, MD, MPH,
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Is there research looking at differences in individual susceptibility to end-organ damage from high serum glucose levels in Diabetes? (in other words, there seems to be a subset of patients who have A1c’s well above target for decades, and yet show no signs at all of microalbuminuria, diabetic retinopathy, or diabetic neuropathy. )
Perhaps part of the individualized approach to intensity of diabetes management (until the genetics of susceptibility to damage are better-defined perhaps) could be based on early signs (or lack of late signs) of end-organ damage independent of A1c levels.
Thanks for these valuable information you’d just mentioned about diabetic and A1C test.
I’ve two questions to ask..
the first question, there are discrepancies between the guidelines on what is the cut off limit of A1c, for example, World Health Organization (WHO) (2011) considered 6.5% as the limit for this test, whereas The National Institute of Diabetes and Digestive and Kidney Diseases considered 5.7% as the limit for the same test. does these variations of the limits has any difference in term of the risk on diabetic patients.
it is widely known that the reasons behind this disease are not clear even thought there are known contributing risk factors like obesity and genetics. my second question is about the possible causes, do you think that “hygiene hypotheses” might be considered as one of the causes of diabetics. as this conditions according to some studies might negatively trigger the autoimmunity.
To rethink A1C Goals and to fight the Epidemic by improved
Awareness, Pre-Diabetes should be from A1C 5.3% or higher
and Diabetes should been defined as from 6% or higher.
Many Doctors complain that by today’s 20 years old definition
of A1C 6.5% until reached already too many damages occur.
This under the view that A1C of 5.5-6% has already the double
heart failure risks compare to the normal healthy A1C of 5% as
proven here in the NIH.Gov Link of 2010: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911067/
The only reliable numbers we presently have from ADA is for
the Pre-Diabetic Fasting Glucose of 100 – 125 mg/dl, where
the Average Glucose of 125 mg/dl represents A1C of 6% !
The ACP guideline are the most unscientific and irresponsible publication. The studies they used did not used the newer agents we have now. Glp1ra, SGLT2i and DPP4i. Not all medication in diabetes management are created equal when taking in consideration CV data. A person who is 65< can easily surpass 10yrs with good medical care. Ignoring the abundant amount of evidence that demonstrates higher glucose levels causes damage to the patient. Hypoglycemia is a risk when using hypoglycemic agents. With other agents, they can achieve a better glucose control with no hypoglycemia risk.
Cost most of the expenses in DM is not on medications but on complication from the disease.
Edwin – That’s exactly what you mentioned. Just not using any
medications with Hypo risks and that’s why I proposed the very
simple but very effective therapy by Metformin Glucophage SR
and 24 hours Basal-Insulin as Toujeo which so fine can been
dosed to set at lowest Fasting Glucose of 80 – 90 mg/dl where
resulting Hypos impossible and the injection by the right technique
can been made pain free as I do it every day. With that therapy
I know many Hypo free with A1C of less 5.6% like normal healthy
people without any problems.
Any good and responsible Prof. Dr. in Endocrinology for in favor
of the T2D patients, is shaking the heads about A1C of 7 – 8%.
It is really disturbing how the matters related to Type 2 Diabetes
just get complicated and confused and that principally where any
Type 2 by the right therapy could easy and without any Hypos
have the A1C of any normal healthy peoples, not like at Type 1.
For example the well experienced Metformin does not create any
Hypos and is still the best to control the Liver-Glucose production.
Daily 2x every 12 hours Glucophage SR 850mg or 1000mg ( SR =
Slow Release over 14 hours ) is not creating any digestion problems.
This combined with a 24 hours Basal-Insulin as Toujeo to set the
lowest Fasting Glucose at 80 – 90 mg/dl for best preconditions.
This offers a 4x daily action, first in the morning measuring the
Fasting Glucose, take one Glucophage SR Tablet and inject the
Basal-Insulin dose and after 12 hours take one more Glucophage
that’s all for the day and provides an A1C of less 6% as more in
direction of normal healthy peoples and this can be made at any
ages or dementia. Why not applying the commonsense therapy.
Further there is not enough considerations taken for the Potassium
Level which for Diabetics should been in the upper halve of the
normal. Remember no Potassium no heartbeats and this where it
also for the Glucose Metabolism plays a key role and this where
by the scientists is confirmed that today worldwide there is a
Potassium deficiency in the populations.
Potassium should been supplemented also at normal healthy people.
Additionally Type 2 Diabetics which by any diets or exercise cannot
reach the normal bodyweight, should receive bariatric surgery as a
There is enough proof worldwide that if the normal bodyweight is
reached, that often the Type 2 disappears and the need for any
medications also or at least much reduced and this also proves
that Type 2 is not just a progressive disease as the medical
industries like to interpreting it.
I’m myself Diabetic with a normal bodyweight and if I go to any
normal doctor he would not find out about if I don’t tell or only
if would do a Peptide-C test then would see about 30% not enough.
My A1C is at about 5% without any Hypos and my Heart function
is SIS 110-120 DIA 65-70 by Pulse 60-70 as it always was and this
with 67 years old and smoking for 30 years, I like to stop now.
I have to admit, that I learned a lot at Google “Twitter WDHCO”.
Diabetes is not that complicate if we just apply commonsense.
The American College of Physicians wants to change standards for A1C levels for no reason other than economics.
They are lying its safe for diabetics to take cheaper medicine that doesnt lower their blood sugar and total hemoglobin gesticulation levels.
People’s health should come before insurance company profits. THEY ARE BUNCH OF GREEDY LIARS. Diabetic should have class action lawsuit against those doctors.
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