In addition to medical intervention, how we eat, move, sleep and think all have the power to dramatically influence our health. What we know and how we approach the treatment of T2D is a dynamic and evolving process, but a thorough understanding of the treatment targets for the disease and how they influence the possible outcomes for patients must be our ultimate guide on the journey to wellness. Wellness incorporates many aspects of health and well-being and means something different to everyone.
One way in which we quantify metabolic wellness is by measuring HbA1c values. This measure of glycosylated hemoglobin has been used as one of the key biomarkers in identifying patients with T2D for more than a decade. HbA1c serves as a reflective measure of blood glucose values over a period of about 12 weeks, and when elevated above 6. Complications include loss of vision, impaired kidney function and amputations.
Complications include heart attacks and strokes. Therefore, a repeated HbA1c value of 6. The significance of this number comes into play when we see how persistent elevations in blood glucose can lead to damaged blood vessels. With more than million U. The health and economic costs of managing, rather than improving, the complications associated with diabetes necessitate a careful look at the treatment options that are available for this disease. In their Guidance Statement 2, the ACP does acknowledge, however, that these recommendations are based on the effects of pharmacologic treatment and that lower targets for glycemic control may be appropriate if achieved via dietary changes and lifestyle modifications like exercise and weight loss.
While this guidance goes against years of substantial evidence-based recommendations, the identification of the potential efficacy of diet and exercise intervention may be one positive, albeit small, take-away from this controversial update.
The ADA reiterated the importance of individualization in any treatment decision for patients with T2D and the avoidance of blanket recommendations based on risks for susceptible members of the patient population.
The ADA further states that de-intensification or simplification of medication regimens for older adults may be appropriate; however, no lower limit HbA1c value for de-intensification has been established for general patients if appropriate measures are taken to minimize the risks of hypoglycemia. One of the most important factors to highlight is that these recommendations are based primarily on the potential deleterious side-effects of intensive pharmacologic treatment.
That is to say, taking a lot of medications to manage T2D can be risky, and may do more harm than you would think. Diet and lifestyle modifications are also mentioned and recommended throughout the various referenced guidelines, but no direction is given as to what this means or how to implement them. We recognize that this may be due in part to the newness of the published results from the Virta Treatment, such that these expert panels have yet to appreciate how truly powerful nutritional ketosis can be in treating the underlying cause of T2D i.
It sounds like we are splitting hairs here. Unfortunately, the numbers do matter. Even if slight, a chronic elevation of HbA1c has been implicated in many diseases due in part to the signals that high blood glucose send out to the body.
So, while the risk of hypoglycemic events is a serious concern that can accompany medication therapy for T2D, chronic hyperglycemia is also an issue with serious health implications. We mentioned the common complications of poorly controlled T2D that include retinopathy, nephropathy, and neuropathy, plus heart attack and stroke—no doubt a scary list!
Epigenetics is the complex interaction between genes and the environment. In other words, environmental influences like diet and heritable factors like the potential for elevated HbA1c can impact the expression of our genes as it relates to health and disease. Hyperglycemia is one of many environmental factors that can lead to epigenetic modifications.
One of the more well-known modifications is DNA methylation. Bear with us on the science here, but it is important in understanding why epigenetics matters when making decisions about treating T2D. DNA methylation is a process by which a methyl group is added to a molecule, and in doing so can alter gene functions, most often by reducing gene expression.
For instance, turning off an anti-inflammatory gene may promote inflammation. This takes us back to the signals that hyperglycemia can send out to the body. In humans, DNA methylation is influenced by diet and exercise and therefore it has been speculated that it may be involved in lifestyle-related diseases. For example, researchers have identified an association between elevated levels of HbA1c and an increase in DNA methylation that specifically reduces insulin production by the beta cells of the pancreas.
We have elevated blood glucose that leads to increased HbA1c which then tells the pancreas to make less of the insulin needed to move glucose into the cells. Thus, the evidence continues to mount for the benefits of achieving and maintaining glycemic control with HbA1c values under 6. However, your personal goal will depend on many things such as your age and any other medical conditions. Work with your doctor to set your own individual A1C goal. People who are older, have severe lows, or have other serious health problems may have a higher goal.
Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings. Keep track and share the results with your doctor so you can make changes to your treatment plan if needed. Skip directly to site content Skip directly to page options Skip directly to A-Z link.
Section Navigation. Facebook Twitter LinkedIn Syndicate. All About Your A1C. Minus Related Pages. If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.
These are permanent, however as red blood cells only last for 4 months new ones are made. That is why your HbA1c can only give an average of blood glucose over the last months.
The more glucose in your blood, the higher the percentage of glycated HbA1c cells you'll have, and the higher your result. This was to make the unit of measure standard worldwide 1. You should determine the right target level for you, together with your Healthcare Professional. This will depend on your type of diabetes therapy, how long you have diabetes and any previous HbA1c results.
If you are an adult with medication that does cause hypoglycaemia i. Talk to your Healthcare Professional about the right goal for you. The calculation below is provided to illustrate the relationship between HbA1c and average blood glucose levels. This calculation is not meant to replace an actual lab HbA1c result, but to help you better understand the relationship between your test results and your HbA1c. Use this information to become more familiar with the relationship between average blood glucose levels and HbA1c.
It should not replace the HbA1c check carried out by your doctor and the result shown here may differ from the lab value you get. This calculation should not be used to make therapy decisions or changes. You can discuss with your healthcare professional how this approximate measurement could help you in your overall diabetes management. The HbA1c is important, but it's not a substitute for structured self-monitoring.
Only regular blood glucose checks show you how meals, activity, medications and stress affect your blood glucose at a single moment in time, as well as over the course of a day or week. Without regular self-checking to provide day-to-day insights, an HbA1c result can be confusing.
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