A1c target 7-8 % ?

[skb]

The American College of Physicians says that A1c targets of 6.5 to 7 % doesn't reduce risks of vascular complications and now recommends physicians to target 7 to 8 % ;

https://www.acponline.org/acp-newsroom/acp-recommends-moderate-blood-sugar-control-targets-for-most-patients-with-type-2-diabetes

Comments ?

[Shanny]

I think the lower, the better. Too many cooks spoil the broth, and some of these researchers only want to publish. They're muddying the waters.

[walkerwally1]

So in their minds if an A1c of 6.5% is not helping then they believe that you might as well let it go higher !  There apparently was never a thought of trying to get it lower, say in the 5% range because they don't know how to do that with the drug only approach to treatment. 

[Grammabear]

I think this new approach is going to come back and "bite them in the butt".  At least this way they can say that more people are meeting 'THE' accepted criteria for A1C.  My last one was 6.5 and I wasn't happy about that, but I'm trying to do better in spite of that fact.

[bigskygal]

This is just about the stupidest thing yet!! Not sure how big pharma is going to feel about this. If they are recommending reducing meds for A1c's under 6.5%, drug companies are going to start to lose money...

[skb]

There apparently was never a thought of trying to get it lower, say in the 5% range because they don't know how to do that with the drug only approach to treatment.

Perfect analysis Wally.

@grammabear, you make a good point about "target" range. Maybe the insurance angle is also at play.

[walkerwally1]

After re-reading the article I have to take back part of my statement.  I passed over this :

"Although ACP's guidance statement focuses on drug therapy to control blood sugar, a lower treatment target is appropriate if it can be achieved with diet and lifestyle modifications such as exercise, dietary changes, and weight loss," said Dr. Ende.

So there is a recognition of treatment other than drugs only.  I do understand that the main reason for having the thresholds higher is that it is impossible to prevent going too low when taking drugs and trying to keep bg really low.  My biggest complaint as that I was never given the alternative to drugs as a treatment.   Back in 1993 when I was diagnosed I didn't even have a computer and the internet was not like it is today.  We relied on our doctor and didn't question what we were told.  I truly believed that what I was doing was the only way to treat my diabetes and that was re-enforced by my doctors, CDE and nurses.  Because the drug I was taking could drop my bg a lot I had to eat without watching carbs and of course i had quite high levels after a meal but my A1c was "good" according to my doctors because it was below 7%.  That is an average of a bg of 154 mg/dl and it is believed that organ damage starts at 140 or maybe even 120.  I think that is why doctors, including my primary, believe that if you are diabetic you are going to suffer from the major complications sooner or later no matter what your blood sugar is kept at.  My doctor bases that on all of the patients she treats but then she told me she has no diabetic patient with an A1c as low as mine.  She has T-1 patients that will test rarely, some not even once a day, so how do you compare all of the rest to me ?  Well, that is what the medical community seems to do all of the time.

[Shanny]

My doc, whose own wife is diabetic, fussed a lot with me in the beginning & was singularly unimpressed with LCHF. But as months went by, being a sensible man, he came around. I don't know if he prescribes it for his other patients, but I know he used it himself for weight loss.

[rocky]

I think the lower, the better.

Very true Shanny.

[skb]

Meanwhile, Indian Doctors Associations disagree with the new targets;

http://toi.in/FU18Bb/a19

[bigskygal]

Since my PCP has declared me "cured" of diabetes with an A1c of 5.5% and said I need no diet restrictions whatsoever, and don't need to test. I have loosened up my diet some. Basically just to prove him wrong. The result is higher fasting numbers but still mostly below 100. I will see him once more in June and wonder what my newest A1c will be. I am worried these new guidelines are going to be detrimental to me getting a rx for strips.

I just shake my head and wonder what is wrong with these researchers!

[walkerwally1]

I think insurance may be part of it.  When I started going to my present PC she was happy to give me a prescription for 4 test strips a day and Medicare had no problem with that for about 2 years.  last year the prescription was cut down to 2 a day and I asked my doctor why she changed the prescription.  She said that Medicare did it because my A1c was so low.  So testing 4 times a day I was able to get my A1c down to a non diabetic range and in their minds that means that I don't need to test that much anymore ! 

[Shanny]

I use the Walmart ReliOn meter & don't need a prescription for strips. Is there any other brand like this . . . Walgreens perhaps?

[Grammabear]

I use the Walmart ReliOn meter & don't need a prescription for strips. Is there any other brand like this . . . Walgreens perhaps?

I've found that anything sold at Walgreens is usually much more expensive than good sold at Walmart.  I've ordered strips through the mail from Walmart.  They are usually quick with their shipping too.

[bigskygal]

I may have to go the Relion route if my PCP won't refill my rx. I don't use medicare rx service, my private ins doesn't restrict my number of strips as long as the dr writes the rx.