Normal HbA1c Levels - What should we be aiming for?

[Dillinger]

It's a tricky one to get a straight answer to that; there is a lot of discussion on here about it but I have just found this old blog that suggests 4.7 to 5.7% is what 95% of non-diabetic are at.

Is that a possible or even achievable level?

Bernstein suggests between 4.2% and 4.6% - but I've only ever dipped into the high 5's

Best Dillinger

http://www.mendosa.com/blog/?p=366

 

[novorapidboi26]

I think getting those numbers for HbA1c would be possible for some at least, but at what cost..........

not just the hypos, but the effort put in with food and exercise and testing.......

your life would engulfed with it all.......

its a delicate balance.....

 

[Avocado Sevenfold]

Is the target different for different types of diabetes?

 

[mo1905]

I don't think you can measure your control on HbA1C alone. For example, a decent avg level of 6mmol may be made up of lots of readings of 3 and 9. I take note of my HbA1C and am very happy with it ( 41 ) but I also look at daily levels and swings.

 

[Wurst]

I personally aim for a non-diabetic HBA1C , the best I've achieved is 5 %'s. I don't have hypo's to achieve this , but it involves daily exercise and low carbing. Can't see how it would be possible without exercise or low carb.

I've read from several different sources that lowering your HB1AC by 1 % reduces the likelihood of complications by over 50% (probably more). So for a small sacrifice (it doesn't have to engulf your life) i.e. 1 hour of exercise per day and carb reduction , you can improve your long term chances of avoiding complications.

Looking to get into the 4% club next test in October...................

 

[Robinredbreast]

Diabetes a tricky one at times and to achieve those results, I think would be rather difficult, I am just speaking for myself and no one else.

The diabetes journey can be a long arduous one at times and the road is often very rocky and bumpy along the way......................

 

[Dillinger]

Is the target different for different types of diabetes?

Well those levels are non-diabetic levels; in the UK the targets are much higher; below 6.5% is the lowest that is suggested (which I think is the level for diabetics with existing cardiovascular disease) and below 7% for everyone else. Most of us fail to get even those levels though; about 93% of Type 1 diabetics fail to get below 6.5% for instance.

I think those suggested levels are too high but I think getting to the 4's would be very difficult for me. It's just interesting I think that it is so hard to get a straight answer to a pretty reasonable question (i.e. what is a non-diabetic's HbA1c).

Best

Dillinger

 

[Bluetit1802]

A non-diabetic's HbA1c is 41 or under. 41 equates to 6.8mmol/l. So I assume a non-diabetic should have an average of 6.8mmol/l throughout the day at the very most.

 

[phoenix]

I was looking for a graph of the distribution of HbA1c levels, I made one myself in the end from the data in one of the papers linked to below .It shows the distribution of HbA1c in the 14000 non diabetic subjects of the US National Health and Nutrition Examination Survey. I haven't done graphs but ethnicity has an influence and participants with an HbA1c between 4.0% and 4.4% were the youngest; those with an HbA1c of 6.0 to 6.4% were the oldest

There are people on the low side of the distribution but why should anyone aim for the lower rather than the middle area of the distribution ?. These are all non diabetics.
There are pros and cons and lots of unknowns.
Risks certainly go up for various conditions with levels above 5%; it's a slow gradual increase at lower levels but the risk definitely increases. Decreasing levels below 6% don't seem to reduce risks by much though
We know in T1 the risk of hypos and more important to me risk of loss of awareness can increase at lower HbA1cs.
In T2 we know that some trials show increased mortality at lower levels but also know these trials used a lot of medication to reduce the HbA1c.
Some research in non diabetics also show an increase in the risks of some conditions with low HbA1cs . (one found increased risks with below 5% another for some conditions at below 4%.)
It may be some low HbA1cs are a marker of an underlying health problem, anaemia, liver problems and Hep C are mentioned ( low levels may be an effect of the disease)
http://care.diabetesjournals.org/content/early/2012/07/30/dc11-2531.full.pdf
http://circoutcomes.ahajournals.org/content/3/6/661.full#T1

I personally think that given we have diabetes ,and for most of us it isn't going away, then we have to set a level that is achievable, safe and gives us the best quality of life possible.

 

[phoenix]

A non-diabetic's HbA1c is 41 or under. 41 equates to 6.8mmol/l. So I assume a non-diabetic should have an average of 6.8mmol/l throughout the day at the very most.

Depends what you mean, averages hide a lot. The ADAG trial from which we get the estimated average levels found that some people had relatively high levels for some periods of the day. They used people with no history of diabetes, a plasma glucose level ≤5.4 mmol/l (97 mg/dl) after an overnight fast and HbA1c <6.5%. and used both CGMs and lots of finger prick tests. This is the time that people spent above various glucose levels.

 

[noblehead]

Any type 1 that gets an Hba1c level of 6.5% or below is doing remarkably well, but I just don't see the value in trying to reduce it too low so that it impedes on your quality of life (much as Novorapidboi says).

I really can't see why Bernstein would want us to aim for unrealistic Hba1c levels when the average non-diabetic are outside this range, does anyone know his reasoning behind this?

 

[drahawkins_1973]

I had my test results back today and they were 42. My consultant said they were too low. I don't have too many hypos perhaps 2 a month. I think partly because perhaps I'm still in honeymoon phase (15 months into diagnosis). I don't really eat a lot of carbs but I didn't really eat many before being diagnosed so haven't changed my diet really. I do work at testing and record all my data well etc but not to the extent that it takes over my life.
But I think it's a personal thing.


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[CollieBoy]

I personally think that given we have diabetes ,and for most of us it isn't going away, then we have to set a level that is achievable, safe and gives us the best quality of life possible.

In a way, as a T2, I agree with this. For me it was a stepwise refinement of BG in trying to reduce HbA1c AND reduce hypers/hypos, doing a cost/benefit/risk analysis of each step so that I am minimizing my HbA1c without un-neccessary hypos without over arduous diet/way of life.

 

[smidge]

Yes, it's a tough one. I was very happy wih 5.4%, not too many hypos, all mild, very few highs. Goodness knows what my next HbA1c will be though because I can't seem to keep my numbers stable at the moment - been on and off like that for several months. Whatever it is, you can bet my consultant will be happier - he wants my HbA1c higher.

He told me that HbA1cs at the low end are correlated with higher incidence of heart disease. I asked how 'normal' HbA1cs can be correlated with heart disease and he said that research is showing that the adrenalin our bodies release when we hypo isn't good for the heart. He didn't give me any links to the research and I'm not sure why it was relevant when i'd already told him I didn't get many hypos. Anyway, that's his professional opinion.

I just wonder how much of our diabetes consultants' professional opinion is coloured by the fact they generally see far more diabetics with very high HbA1cs than those with normal HbA1cs. Just a thought.

Personally, I'd go for the lowest HbA1c that I can safely achieve.

Smidge

 

[Wurst]

Any type 1 that gets an Hba1c level of 6.5% or below is doing remarkably well, but I just don't see the value in trying to reduce it too low so that it impedes on your quality of life (much as Novorapidboi says).

I really can't see why Bernstein would want us to aim for unrealistic Hba1c levels when the average non-diabetic are outside this range, does anyone know his reasoning behind this?

His reasoning is to avoid any diabetic complications , additionally he achieved these HBA1C target levels and by doing so reversed a number of diabetic complications he was suffering from. I've read the book several times , it's my diabetic 'bible'.

 

[CollieBoy]

Yes, it's a tough one. I was very happy wih 5.4%, not too many hypos, all mild, very few highs. Goodness knows what my next HbA1c will be though because I can't seem to keep my numbers stable at the moment - been on and off like that for several months. Whatever it is, you can bet my consultant will be happier - he wants my HbA1c higher.

He told me that HbA1cs at the low end are correlated with higher incidence of heart disease. I asked how 'normal' HbA1cs can be correlated with heart disease and he said that research is showing that the adrenalin our bodies release when we hypo isn't good for the heart. He didn't give me any links to the research and I'm not sure why it was relevant when i'd already told him I didn't get many hypos. Anyway, that's his professional opinion.

I just wonder how much of our diabetes consultants' professional opinion is coloured by the fact they generally see far more diabetics with very high HbA1cs than those with normal HbA1cs. Just a thought.

Personally, I'd go for the lowest HbA1c that I can safely achieve.

Smidge

Know what you mean,
I'm T2 on D&E , but still see a consultant. He says that I MUST be having hypos, despite having done random BGs through the night THANKS wife!. Have asked for evidence that i don't pull my bG back up like a non-D but no joy! Dogma says i must be hypoing so no allowing reality/evidence getting in the way!

 

[iHs]

There are quite a lot of type 1 diabetics who have been so for about 40 years or more who have achieved mediocre bg levels with hba1c of about 6.9 to 7.2% who havent developed any complications and even those that have, the most its been is frozen shoulders (anyone can get them), carpal tunnel syndrome (anyone can get it) and background retinopathy. The background retinopathy is usually halted by slightly better control and being a bit less laid back on carb counting and the timing of injections.

 

[Dillinger]

There are quite a lot of type 1 diabetics who have been so for about 40 years or more who have achieved mediocre bg levels with hba1c of about 6.9 to 7.2% who havent developed any complications

That's because we're looking at a range of probabilities for complications developing. The DCCT showed that for every 1% drop in HbA1c the range of complications drop.

Just because Keith Richards is looking quite sprightly on a lifetime of smoking, drinking and heroin doesn't mean we should all do that...

The implication of the 'normal HbA1c' is that whatever the normal level is will be the level at which your risk of complications is the same as that of a non-diabetic.

Best

Dillinger

 

[Dillinger]

I had my test results back today and they were 42. My consultant said they were too low.

Ignore your consultant; that is atrocious advice. Have a look at the DCCT trial which governs who we are treated in the UK.

http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000390

You are doing very well according to that.

Best

Dillinger

 

[Wurst]

There are quite a lot of type 1 diabetics who have been so for about 40 years or more who have achieved mediocre bg levels with hba1c of about 6.9 to 7.2% who havent developed any complications and even those that have, the most its been is frozen shoulders (anyone can get them), carpal tunnel syndrome (anyone can get it) and background retinopathy. The background retinopathy is usually halted by slightly better control and being a bit less laid back on carb counting and the timing of injections.

Everyone is different and I personally don't want to leave it to chance ! The only sure way to avoid complications is to keep your levels in the non-diabetic range