New Guideline on Role of Hemoglobin A1c Level for Monitoring Blood Glucose for Control of Type 2 Diabetes

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Diabetes affects hundreds of mullions of people worldwide, including over 30 million in the U.S. One might question why is this post suited for the blog focused on gut. Two reasons as below:

1. The pathogenesis of diabetes type 2 is intricately connected to intestinal bacteria and leaky gut or intestinal hyperpermeability as published by many studies in prestigious journals like Cell Metabolism,  Diabetes & Metabolism and Gut. 
2. Diet and obesity play a role in diabetes overall and diabetic diet is part of treatment plan for type 2 diabetes. I have also written on this before in my blog and also in my books.

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What is hemoglobin A1c or Hb A1c and how is Hb A1c used for glucose control?

Glycosylated hemoglobin commonly known as hemoglobin A1c or Hb A1c is a popular method for monitoring adequacy of blood glucose control as it averages out glucose control over a period of preceding 3 months.

As with most tests, the results are subject to lab error variability and may also vary by gender and race. The precise HbA1c level that is ideal remains to be established

Recent 2018 Guidance on role of American College of Physicians on role of Hb A1c are summarized below:

1. Individualize goals based on clinical factors, life expectancy and cost versus risks of medicines.
2. Goal should be a HbA1c between 7% to 8% in most patients. Different organizations may offer different goals.
3. “Deintensify” medication use in cases of HbA1c less than 6.5% by reducing the dose or number of medications employed In any particular patient. This will reduce the cost of drugs as well as risks of harm to the patient.
4. Avoid a target HbA1c in asymptomatic (no diabetes related symptoms) patients with life expectancy less than 10 years (80 years or older), nursing home residents and those suffering from dementia, cancer, end stage heart failure, COPD or chronic kidney disease.

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Caveat: The American College of Physicians acknowledges that there is insufficient evidence to assess the clinical impact of HbA1c levels between 6.5 and 7%.

The guidelines for oral medication use in diabetes type 2 were published by Qaseem and and colleagues on behalf of the ACP in Annals of Internal Medicine, 2017.

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