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RE: [IP] A1Cs

email @ redacted wrote:

> IMHO, A1Cs are pretty useless.   I test around 6 to 9 times 
> per day, and 
> those tests give me useful info.  A1Cs may be interesting, I 
> know, and they 
> give a big picture for a long period of time... but 
> practical?  Useful?  How?

Actually, it's the other way around . . . well, not really.  Personal
testing is certainly not useless.  But HbA1c is the best indication of
overall control and is the primary prognosticator of diabetic complications.
Self testing is an excellent way to maintain good control, but our test
meters do not have the accuracy and precision required for either diagnosis
or prognosis.  They are good tools to detect trends, but not much more.  No
one should consider any single test on a typical meter to be *the*  blood
glucose level.

You also wrote:

> As I recall, no A1C was magic.  Better control means better 
> health. I'm pretty sure that was the bottom line.

While I agree that HbA1c is not magic, it means that better control reduces
the *probability* of developing complications.  The cutoff, according to the
DCCT, is an HbA1c of 7.0, that is the reduction of risk for diabetic
retinopathy was not statistically significant below 7.0, but it was for
values over 7.0.  Further, the risk increased almost exponentially with an
increase in HbA1c over 7.0.  From another source, I've heard that there is a
paper in preparation, however, that suggests that diabetic retinopathy onset
can be associated with HbA1c levels as low as 6.2.  I have no details of
this paper.

But I will repeat that all of these deal with the probability or risk of
developing complications.  Having a low HbA1c is no guarantee that we will
not develop complications, nor it is saying that someone with a higher HbA1c
will develop complications.

Jim Handsfield
Centers for Disease Control and Prevention
mailto:email @ redacted OR
mailto:email @ redacted

The opinions expressed are my own and do not necessarily represent those of
the Centers for Disease Control and Prevention, the United States Public
Health Service or any other agency of the United States government.
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