Target hba1c

what is the range that a hba1c should be in? that is, a target without constant lows and diabetes controlling your life each and every minute of the day?
what do you realistically aim for?

here are my stats…
Type 1 since 3/2000
MDI --> Humalog + HumulinN
Last A1C’s: 5.8, 6.0, 5.9, 5.8, 5.6

I think a healthy target range for a type 1 is 5.5 - 6.5; but I’m no doctor, and everyone is different

Through the years, the Lab reference range here for A1c was below 7.0. This past year or more, I noticed that the reference range on my test results has been between 4.8 and 6.0.

I prefer my A1c range to remain between 6.5 - 5.9.
My last 2 year A1c’s were: 6.3 and 6.4. Boring but stable. A few A1c’s just before those I also had: 6.2, 6.5 and 6.7.

My target range is from 5.5 to 6% which is the upper range of a healthy person (4 to 6%). I would recommend to stay below 6.5% to reduce the risk of complications.

I think it is important to approach these goals strategically. It makes little sense to reduce the post meal values if your morning values are often to high. So tackle the morning problem first. It has the most influence on your A1c because it is likely that these high number were elevated for longer periods of time.

The biggest improvement can be achieved when your basal needs are truly covered. So you should run tests with your endo to verify that the basal coverage is good.

If this has been sorted out then the post meal situation should be dealt with. Try different waiting times before you eat and watch the aftermath. Are there sites to apply the shot that turn out to absorb the insulin with less reliability? Am I reacting appropriate to the given insulin? Are there other insulins I could try to reach better control? What about sport - can it help to improve my general sensitivity to insulin?

Im a type 2. I started off with A1C of 9 when first diagnosed. Three months after it was 6.6, after a year it’s 6.3 then to 6.1. October 2009 I was at 6. Im already extremely happy. I think some health care providers recommends an A1C less than 7 percent for most adults with diabetes. (Im not sure for children). My doctor and I are working to keep mine between 5.8 to 6.5. Right now, my doctor is literally jumping for joy!

Good question… and the answers can unfortunately vary quite a bit.

Over the decades I’ve seen the targets be revised downwards. In my early days 8% was o.k., then the 7%s were fine and now the hospital I go to in the UK recommends a target range of 6-7% although my GP surgery will accept 7.5% and below as decent control. Confusing, huh? I think the best option is to ask your diabetologist’s opinion for what you should be aiming for at your current stage of life. Bear in mind though that as the years roll by we’ll probably see these recommendations subject to further revision.

As far as your other question goes, diabetes does control your life every minute of the day, but it’s a question of limiting the control you feel that it has over you.

I also came to my mind that the method of A1c measurement could be different from country to country. Does anyone know if the A1c is internationally standardized?

You would think that it is or should be, wouldn’t you? When I was last at the hospital diabetic clinic I was given notification that after 31 May 2011 HbA1c will cease to be reported as a percentage and that the target range will be given in mmol/mol, a new IFCC reference method that is a “more specific way of checking HbA1c […] and will now be standardised across laboratories internationally”, according to the leaflet I was given. The target will be 45-55 mmol/mol.

wow you’ve had awesome averages, well done!

really helpful reply, thanks!

Don’t confuse a lab reference range with your target. The lab reference range is the interval over which 95% (or two standard deviations) of the “normal” (i.e. non-diabetic) fall into. Different labs may well have different reference ranges. Some actually don’t measure the statistics and just make up numbers, but bear in mind that in any case, that range is to give the doctor an indication of when a reading is out of the range of that expected for the “non-diabetic” population. That does not necessarily make it appropriate as a target for you as a diabetic, let alone you as an individual.

The most recent guidelines will tell you that generally the goal is < 7%. In diabetics who can manage it, the goal should be as close to normal as possible (so, essentially < or close to 6%). The goals should be less stringent in certain “at-risk” populations (ie, small children, people with limited life expectancy, significant health problem, history of significant hypoglycemia, etc).

The best answer is “it depends.” If you’re perfectly healthy and have no issues with hypoglycemia, get your A1C as close to 6% as possible. If you have other issues, your practitioner and you should work together to find a target.

Ref: Standards of Medical Care in Diabetes - 2009 (ADA)

If you mean the target range, then no, there is no international standard. Different associations and academies publish their own recommendations yearly.

If you’re referring to the technology, I’m not sure, but I would guess that there is no consistent standard for measurement. Even within the US I would guess that different labs would give you slightly different numbers. Whether this difference is significant would be the question, I guess. Sounds like Stephen may be hearing some new interesting things though…

Yes Holger - excellent reply - your words say it all!

Very interesting Stephen. I live in Canada where we use the “Systeme International” unit for measuring BG’s - mmol/l - compared to the US and other countries that use mg/dl (for example my German friends measure in mg/dl). I know there has been talk that this will be used world wide, but when I mention this to people they just about chop my head off (off with her head)!
One day tho’ it would be good for the whole world to use one standard way of measuring BG’s - A1C’s (like the IFCC)! Less confusing!