Individualizing Patient Care: Does that Include Individualizing A1C Goals?

Sherry first came to see me months earlier to better manage her diabetes. I helped her with diet, exercise, and more consistent and strategic blood glucose monitoring. Her physician adjusted her medications. In just a couple of months, her A1C dropped significantly to 6.8%. She had met her goal and the general recommendation of the American Diabetes Association (ADA) to attain an A1C level of less than 7%!Lowering A1C to this level reduces the risk of microvascular complications of diabetes. And if people with diabetes achieve this level of blood glucose control early in the course of the disease, their risk of heart disease is also reduced.While we were celebrating her success, she expressed concern for her mom, whose A1C was recently measured at 7.9%. Sherry told me that she questions the competence of her mom’s doctor because he told his patient to “keep up the good work.” How could he let her think that an A1C of 7.9% was good, Sherry was asking. This is not an uncommon concern.General recommendations from the ADA are to attain an A1C of less than 7%, but this is not the appropriate goal for everyone with diabetes. Like medications, diet, and physical activity, blood glucose goals must also be individualized. For some people with diabetes, an A1C of less than 6.5% is ideal, and for others a good goal is less than 8% or even 8.5%, according to a 2012 consensus report in the Journal of the American Geriatrics Society and Diabetes Care.Studies show that tight glycemic control among people who have had type 2 diabetes for 20 or more years or have extensive atherosclerosis may actually boost their risk of mortality.An appropriate A1C goal falls somewhere in the range of less than 6.5% to less than 8.5%. Higher than 8.5% puts the individual at increased risk for dehydration, poor wound healing, urinary tract infections, and hyperglycemic hyperosmolar syndrome.With this knowledge, registered dietitian nutritionists, certified diabetes educators, and other allied health professionals working with people with diabetes can help patients understand the A1C goals and recommendations set forth by their healthcare providers.By Jill Weisenberger, MS, RDN, CDE, FAND