If You Have Type II Diabetes, What Target for Lowering Your HbA1c Should You Have?

If You Have Type II Diabetes, What Target for Lowering Your HbA1c Should You Have?
 

There is a debate among experts what target level of Hemoglobin A1C should be your goal.(1)  Hemoglobin A1C, which stands for glycated hemoglobin, is believed to reflect your average blood sugar readings over a 3 month period.  The American College of Physicians just released new guidelines recommending that the new goal for HbA1C  should be between 7 and 8 but the American Diabetes Association disagrees, feeling that the goal should be to lower HbA1C below 7.(2) The American College of Physicians (ACP) made this recommendation based on some studies showing that when you aggressively try to lower blood sugar levels with using more and more medications at a certain point, you end up with too many side effects.  These negative effects include the blood sugar dropping too low–hypoglycemia–but also increased risk of heart disease. But elevated levels of glycated hemoglobin means that you increase the risk of the vascular complications of diabetes such as heart disease, strokeheart failurekidney failureblindnesserectile dysfunctionneuropathy, poor wound healing, gangrene, and gastroparesis (slowed emptying of the stomach).

 

The ACP based their recommendations on several clinical trials, including the ACCORD Trial, which was ended early due to a 22% increase in all-cause mortality, a 35% increase in cardiovascular-related deaths, and a 3-fold increase in risk for severe hypoglycemia in those who received intensive therapy.(3) What this tells me is not that it is a bad idea to lower your HbA1C below 6.5 but that when you do it by using an increased amount of drugs, you increase the potential side effects, which is not surprising. This is especially the case with using insulin and sulfonureas, as opposed to the newer categories of drugs, like GLP-1 analogues & SGLT-2 inhibitors. Each of these older drugs have more potential side effects, including increased heart disease, and when you combine multiple drugs, you are compounding this effect. This is quite a bit different than using diet, exercise, and lifestyle changes to lower HbA1C levels, which is the approach that we take at Weitz Sports Chiropractic and Nutrition.

 

Another trial that the ACP based their recommendations on is the ADVANCE trial which did achieve HbA1C levels of 6.5 and did not see an increase in the risk of death but it did result in a lower risk of kidney problems.(4) The risk associated with this trial was increased incidence of severe hypoglycemic events, meaning that at times the blood sugar dropped too much, which risks falling into a diabetic coma and dying. Once again, if you can accomplish this with diet and lifestyle changes, the risk of hypoglycemia is less, provided that the program is not too severe in limiting all carbohydrate foods.

 

Type II Diabetes is a disease directly related to diet and lifestyle and if you don’t significantly change your diet and lifestyle, it will only get worse. Medication only manages your downhill ride. The only way to change direction is to eat a low carbohydrate healthy diet such as Paleo or Keto or low glycemic Mediterranean, exercise regularly, and lose weight (if overweight). However, if you use a very carb approach, like keto, be very careful not to let your blood sugar drop too low and it would be best to work with a practitioner, like myself rather than doing it on your own. Make an appointment today to see Dr. Weitz for a nutritional consultation and hire him be your health coach till you reach your health goals. But expect this journey to take a number of months and perhaps a few years, but the benefits are worth it.

 
References:
2.  Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Ann Intern Med. 2018;168:569-576.
3. Gerstein HC, Miller ME, Byington RP, et al.  Action to Control Cardiovascular Risk in Diabetes Study Group Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358:2545-59
4. Patel A, MacMahon S, Chalmers J, et al. ADVANCE Collaborative Group Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358: 2560-72.
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