Each time you get the results of an A1c test, you may cheer if it’s below the oft-quoted target of 7 percent – or worry if it’s higher. But is 7 percent really the goal that everyone with type 2 diabetes should strive for?
If you have followed diabetes research for years, you may have noticed a trend: doctors continue to discover that diabetes is a condition that varies from person to person in a variety of important ways. For example, eating the same food may cause some type 2 patients to have a spike in blood sugar levels while other patients aren’t affected as much. Similarly, there is increasing agreement among experts that when it comes to A1c recommendations, one size does not fit all. The best A1c goal for one patient may not be ideal for another.
What Your A1c Test Shows
The A1c test (sometimes called hemoglobin A1c, HbA1c, glycated hemoglobin, and other names) helps your doctor diagnose diabetes and then track how well your diabetes is controlled. Unlike the blood glucose tests you administer with your meter, which show your blood sugar at one moment in time, the A1c test reflects your average blood sugar level over the past few months. It’s an important look at the “big picture” of your diabetes. The A1c can help you and your doctor know when lifestyle and treatment adjustments are needed to keep you in the target range that helps you feel your best.
There is plenty of sound research to show that lowering the A1c to 7 percent or less helps prevent diabetes complications. But now, many doctors believe that an A1c target between 7 and 8 percent may be appropriate in some cases. Patients who may qualify for this more relaxed goal include those whose blood sugar dips dangerously low at times, those with a limited life expectancy, those with advanced diabetes complications, and those who have had long-term difficulties reaching a stricter goal.
But what about the majority of type 2 patients who don’t fall into those categories? Is 7 percent the best goal for them, or would a lower number – a more aggressive goal – produce even better results?
The answer appears to be “It depends.” In some patients, the risks of more aggressive blood glucose management may outweigh the benefits. Chief among those risks is hypoglycemia. Some doctors fear that medicines powerful enough to produce an A1c of 6 or 6.5 percent may produce low blood sugar levels that could jeopardize your health. Other doctors say those fears are based on using older diabetes medicines, and they believe that newer classes of drugs can deliver lower A1cs safely.
What’s Right for You?
As you seek to make sense of different A1c recommendations, the first thing to do is talk with your doctor about how – or whether – they apply to you. Your own type 2 diabetes history, blood sugar control, general health, and other factors should be considered. And just as diabetes treatments may change over time, your A1c goal may too. Simply understand that the 7 percent recommendation you may have believed was universal is a guideline that is useful for many type 2 patients – but not everyone.