Misunderstanding UKPDS - 7% is NOT a Good A1c.

The ADA board is full of people with A1c test results over 7% whose doctors tell them they are doing fine. They aren't. The doctors who tell them this are as irresponsible as if they told them not to worry about a "touch of cancer."

My guess is that uneducated doctors think an A1c near 7% is "fine" because they've only read the one line summary of the findings of the UKPDS. That "25 words or less" version is that people with Type 2 Diabetes who attained A1cs of 7% reduced the incidence of complications.

What this summary statement ignores, is that UKPDS also showed that, while the rate of complications in the population with A1cs of 7% was better than that in the population with A1cs of 9%, people with those 7% A1cs still developed microvascular complications at a very significant rate, and, even more importantly, they had not decreased their likelihood of dying from a heart attack or stroke.

Here's what the actual findings published in the British Medical Journal said:
Each 1% reduction in updated mean HbA1c was associated with reductions in risk of 21% for any end point related to diabetes . . . No threshold of risk was observed for any end point. [i.e. this stayed true as the A1cs continued to drop] . . .Any reduction in HbA1c is likely to reduce the risk of complications, with the lowest risk being in those with HbA1c values in the normal range (<6.0%)."

Does this sound to you like 7% is a good A1c? I don't think so.

Even more significant is that other studies show that to decrease the incidence of cardiovascular "incidents" i.e. heart attack and stroke, you need to lower A1c far below 7%.

The chart below, derived from the huge EPIC-Norfolk study makes it very clear that the risk of heart attack DEATH has already doubled at an A1c 6%. (from Medscape New Avenues for Complicated Patients with Type 2 Diabetes and Hypertension) The chart graphs the risk of death from various causes for various A1c levels. CHD: Coronary Heart Disease. CVD: Cardiovascular Disease (includes stroke).




Could any doctor who looked at this data complacently tell a patient that an A1c of 7.3% was fine?

Clearly, the only A1c that is truly "fine" is 5% or less. Many of us can't get there. I sure can't. But the 5%s are a whole lot better than the 6%s and with the 7 times higher risk of death at the 7% you'd have to be crazy to be complacent about an A1c that high.

If this is all making you nervous, don't despair. I know literally hundreds of people who have brought their A1cs into the 5% range, often starting from as high as 13%. The tools you use are cutting back on your carbohydrate intake until you can get under 120 mg/dl two hours after every meal and, if carb restriction isn't enough, well chosen meds, including the one drug that always works for people with diabetes: Insulin.

Normalizing blood sugar saves lives. It can be done. It must be done. And if your doctor won't help, find a new doctor. It isn't his eyes that will go blind, his feet that will get amputated, or his heart that will give out when you take his outdated and dangerous advice!