When is to comes to Hemoglobin A1c is lower always better? This widespread belief has been challenged in a Sweedish study reported in Heartwire by Shelly Wood and described in Medscape news as Registry Data Support “J-Curve” CV Rsik Theory for Hba1c in Diabetes. Please read the article and comment below about your struggles with your A1C.
Two studies completed in the United States (ACCORD and ADDITION) have shown when pills or insulin were used to treat type 2 diabetes, the lowest incidence of cardiovascular events occurred somewhere between 6 and 7. This finding was verified in the Sweedish study just reported. In that study, the groups were also separated by level of education, and only those in the lower education group had an increase in events when the A1C was below optimal levels. There are no good clinical trials proving that it is harmful to lower A1C too far, and at this points scientists are speculating about the reason for this finding.
Dr. Kramer comments: There has been speculation that future diabetic guidelines may include a minimum recommended value for the Hemoglobin A1C. However, scientists are still trying to understand the reasons for this unexpected finding. They feel that people who are under tighter control may have more hypoglycemia or some other side effect from the medication. The people who have decreased their A1C by diet and exercise alone, have not experienced a rise in cardiovascular events with decreasing A1C. This reinforces the idea that lifestyle changes ie diet and exercise should be the keystone of treatment for Diabetes type 2 and physicians should encourage their patients to do the best they possibly can. Medication and insulin should be added to lifestyle modification and used appropriately and correctly to achieve the best results. Check with your doctor to see where your hemoglobin A1C should be.
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