Actually, just think of it as the automobile going from standard transmissions to automatic and soon to autonomous. It is just a progression that make for easier and safer driving for most everyone. I think most people agree that once you adopt the latest diabetic technologies, you never want to go back to the not so good old days even if your A1C was good.
With CGM, I have been able to experiment and eat 100’s of new foods that I never dared or was too lazy to try before in fear of how they would affect Blood Glucose and just too much work to try to figure it out with finger sticks.
Dexcom has default ranges set up in their application. But the default BG range can be modified to suit each individual patient. Additionally a base rate can be set for day time versus night time. A1C was based on a general population and then formulas used to calculate average blood glucose to A1C ratios. That formula can be off quite a bit for individuals. My actual A1C was always showing about 20% higher than when it was based on average blood glucose readings, including BG readings done at the clinic.
Now Dexcom uses GMI Glucose Management Indicater which in theory is same as A1C but it is adjusted for an individual rather than based on the general population. So my GMI actually now matches my A1C since it is not based on a general population computation.
The International community has set the standard so everyone is measured the same way, but I have not heard anything yet about that community establishing range standards beyond what the vendors such as Dexcom are doing.
No studies have yet been done that demonstrate that average, TIR, or standard deviation measures are better indicators than the A1c of the risk of long-term complications.
A1c is the gold standard because studies have been done that show it as the best indicator of your long-term risk.
While all these metrics are important and useful, the A1c has not been replaced by them.
Yes, this requires CGM. Many but not all T2’s currently qualify to get CGM reimbursed by insurance and/or Medicare. Like all technologies, CGM prices should drive down dramatically over the next several months as more companies get into the game and insurance companies realize how much of a game changer this technology is to lowering long term complications from diabetes.
I am not sure that is quite true. I believe that there are several studies that show both frequent Hypo and Hyper glycemia events lead to complications down the road.
“While all these metrics are important and useful, the A1c has not been replaced by them”
The A1C will in all likelihood never be replaced, just used as an initial indicator to determine if a patient is diabetic or not. These new metrics will be used to better manage and control diabetes.
Personally I don’t need a study to prove that. I pay more attention to daily CGMS. But everyone doesn’t have CGMS, so for them A1C would still be a good reference.
A1C is helpful for my endo, so we don’t spend much time reviewing my daily BGs. If my A1Cs started to trend up from my goal, I would pay more attention and make changes if necessary.
Please Mom, don’t worry!!! It will be ok. You and your whole family are in a major life changing learning curve. And you cannot possibly learn it all right away. So just continue to learn, ask questions and learn from the “mistakes”? Every day is an experiment and a learning experience. And with children, there is another whole dynamic to the whole thing. They decide they’re not hungry after taking insulin, or they eat more than you planned for, or they are running around like a crazy person for the whole afternoon, or they decide to veg in front of the tv for the afternoon. How can you possibly plan for all of it.
So do the best you can and I really don’t think a 7.5 is a crazy goal. When you think that most teenagers are in the 8’s, your goal is in line. Keep in mind when the hormones start raging, it gets very challenging and different treatment plans may come into light.
Good luck and take each day as a new experiment in the making and learn from each experience. You’ve got this!
You are assuming that all people with diabetes will be given CGMs. Perhaps in another universe but given that many people with diabetes have to to fight for 4 strips a day, I don’t see the A1c being totally replaced as a measure of control any time soon.
Yes, that is my assumption based on the number of companies around the world working on CGM’s. It is all a matter of Cost/Benefit and with a growing recognized diabetic population worldwide I can see competition drive the cost of CGM’s to be in line with cost of Glucose meters so even without any insurance, patients will go out and buy them.
I agree. I use all these other measures so that I feel good day to day and so that I can keep my A1c as low as possible without lots of hypos because there’s solid evidence that your A1c indicates your risk of long term complications.
For someone with an A1c in the 7s-8s or higher, studies have shown that the risk of long term complications is higher, regardless of whether they have the same average and st dev of someone with an A1c in the 6s. An A1c value correlates with a range of average bg levels, and the A1c matters more than the average because it’s an indicator of how much glucose is attaching to proteins in the body in an unhealthy way (creating AGEs).
Anyway, I’m not trying to be controversial. I just think sometimes we get so focused on all these small (but important) numbers that the big picture number gets discounted. That big picture number is important because we have solid evidence showing a lower number reduces long term complication risk more than any other number/measure.
To the mother of that kid diabetic, one morsel from which I have gotten a bunch of warm fuzzies is that “Your Diabetes May Vary”.
It means that some of us shoot insulin, some of us swallow pills, some eat no carbs, I eat carbs but I love salads, a lot of diabetics exercise. I can’t. And some diabetics never even treat there illness. Whew! There is a multitudinous universe of different kinds of diabetics. Have fun with it.
Not me!! I’ve been putting off getting the blood draw for my next a1c for a year now I don’t really see the benefit of it - I have a CGM and my doctor could easily access that information if she needed to. Endocrinologists haven’t really been much help to me for about ten years now; I really just see them when I need a new prescription. I’ve had a lot more luck discussing any issues with other diabetics, and finding treatment solutions online than going to the doctor for help. I currently see a really busy endo who rushes me in and out, so maybe that’s why I feel this way. I’ve had better relationships with doctors who have a bit more of a personal touch and spend more time with me in the past. So I’m choosing to ignore the a1c for now, we’ll see how that goes.
To be honest, I think your A1C is good in either scenario. It made sense to keep it high enough to be able to work without having to constantly nibble. An A1C of five something is amazing, and (just my personal option) not really necessary to keep it that strict. I am not advocating throwing caution to the wind, but anything less that 7.0 is optimal, and to the best of my knowledge there is no physiological advantage to keeping it in fives.
I am satisfied with A1C from blood lab, don’t rely on the in office tests done in office. The number itself is just a number, and I’m excited when I see improvement after making treatment changes.
My first A1C was done in 1983ish. I think it was in the teens. Was only on single daily injection of Lente at that time, since I was 5.
Didn’t reach A1C in 9s until 10+ years later, using Reg+NPH and exchange diet. Dr gave patients a star when we got to 9s (before DCCT results). So my perspective is a bit different, and appreciate all the advances since then.
I don’t really see the benefit of it - I have a CGM and my doctor could easily access that information if she needed to. Endocrinologists haven’t really been much help to me for about ten years now; I really just see them when I need a new prescription. I’ve had a lot more luck discussing any issues with other diabetics, and finding treatment solutions online than going to the doctor for help. I currently see a really busy endo who rushes me in and out, so maybe that’s why I feel this way. I’ve had better relationships with doctors who have a bit more of a personal touch and spend more time with me in the past. So I’m choosing to ignore the a1c for now, we’ll see how that goes.