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Non-Diabetic A1C ("normal"): 4.5 - 6.0?

Question:
Dr. Bernstein had an "opinion".

The science is a little different. FINALLY, I found a discussion of this by someone who understands populations and standard deviations.

Enjoy:



Of course, one response to this is to claim that most of these "normal" people are "on the road" to diabetes but simply haven't arrived yet. First, that couldn't involve more than the percentage who will actually develop the disease and second, a follow-up would be in order to trace long-term histories of people at the various levels.

Meanwhile, 4.5 - 6.0 covers 95% (3 SD's) of the non-diabetic population, with a little heavier weighting in the high end.
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Maybe I missed something, but the latest test was based on 29 people from central Missouri and that was the criteria to raise the A1C "normal" numbers?

The lower we can keep our A1C, the less complications down the road. The higher our A1C, the more drugs to take and profit the drug companies.
Answers:
catalinagal,

Dr. Bernstein is a type-1 and it has never been clear why a type-1 and type-2 should have the same goals. Why should a senior and a teen have the same goals? Trying to reach Dr. Bernstein's goals can be very dangerous for a type-2 with high insulin resistance. To reach such a goal would result in life threatning lows for some. To reach Dr. Bernstein's goals for a type-2 one must treat the insulin resistance first and to have a stable enough glucose for such a low target, a person needs to be in exceptionally good shape.

The problem is that there is no ONE size fits all treatment for diabetes and that goes for setting diabetic goal as well. Type-1 (no insulin) and Type-2 (insulin resistance) are different diseases with different underlining causes, although they are related.

Chuck
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Chuck,

We are not in agreement

Still doesn not make sense for 29 people to be the criteria for a1c.
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No, not to "raise" them but rather to CONFIRM what they had been saying all along. Definitely agree with your second paragraph and I don't intend to EVER "donate" any profit to the drug companies.

I just think we should accurate in what we say. There's nothing wrong with saying "As a diabetic, you should strive to do BETTER than a substantial portion of the non-diabetic community." It should not be necessary to redefine "normal" to motivate ourselves.

Also, more research is clearly needed on BG levels of people who live out their entire lives without getting diabetes. It seems very little has been done. I don't think you can just reject that there could be millions living at A1C 6.0 (and equivalent spot numbers) without ever developing the disease.

It would appear 4.5 - 6.0 covers 95% of the non-diabetic population. How many of these are likely to become the new cases in the future? 10% maybe? The numbers just don't seem to indicate that the only "truly normal" A1C is 5.0 or less.

I am NOT advocating higher targets, just more accurate speech.
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I agree with Salim on this. There hasn't been enough long-term research done on which "normals" do/do not go on to develop diabetes. If people want to set really ambitious targets for themselves that's great, but the upshot may be that people incapable of such tight control throw in the towel because maybe the best they could have done was a 6.5. I'm not sure there ought to be any shame in a number like that.
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Or worse yet, take chemical medications to achieve those "ambitious" targets with the possible consequences of THAT without really knowing if there were strong reasons to do so.

I'm new to this, but hovering around 6.5 sure feels a lot better than 10.7 and so far I have zero indications of any impending complications. Would I like to be below 6.0? Yes, I suppose I wouldn't mind, but I wouldn't take any extreme measures to get there barring better evidence of the need. And in my book, all chemical pharmaceuticals (of which I still take NONE for anything) are "extreme measures".
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The ADA and AACE don't base recommendations on 29 people!! Age changes what should be average A1c recommendations. What the ADA says is that lower than 7.0 is better but not much while getting A1cs under 7.0 has a big affect on complications. The question of lows and side effects play a role in deciding how low to set target A1cs.

If you wish to believe that fitness doesn't play a big role in complication prevent as well as glucose control, there is lots of research to contradict you.

As far as treating type-1 and type-2 differently, my opinion is that the approach should be very different and that has worked great for me over the last 14 years.

Chuck
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Chuck,
I am glad it has worked for you for 14 years! That is a good thing

I stand corrected, I went back and re-read the article - You are right, the ADA & AACE do not base the A1C on 29 people -

Interesting discussion. Thanks all for your input
Answers:

No, not on 29 people. Instead they base it on flawed studies like ACCORD or similar.

My longer opinion is here: .
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