Re: Defending ADA's A1C Target


"Alan S" <loralweightandcarbs@xxxxxxxxxxxxxxx> wrote in message
news:cb5oo1lq5a6co8qj40g1nc9ln824jjtctm@xxxxxxxxxx
> On Mon, 28 Nov 2005 22:33:38 -0800, "Sarah"
> <sarahpa1980nospam@xxxxxxxxx> wrote:
>
>> http://tinyurl.com/bmydm
>>
>>
> Interesting article. The basic flaw for type 2's appears
> here:
>
> "However, we must consider the cost-benefit relationship.
> Placing the patient on another oral medication or starting
> the patient on insulin needs to be weighed against the
> potential benefit of further A1C reduction. If the question
> is, "What should be done to decrease my patient's A1C from
> 6.9% (meeting the ADA target) to 6.5% (meeting the AACE
> target)?" it must be realized that within that range of A1C
> reduction the potential benefit is small indeed, based on
> current data."
>
> Read that again, and see if you can find any mention of
> diet, lifestyle or exercise. The basic assumption is that
> the ONLY way to decrease the patient's A1c is "another oral
> medication or starting the patient on insulin".
>
> And, unfortunately they are correct if the philosophy
> followed is based on this:
>
> "The message today: Eat more whole grains! Whole grains and
> starches are good for you because they have very little fat,
> saturated fat, or cholesterol. They are packed with
> vitamins, minerals, and fiber. Yes, foods with carbohydrate
> -- starches, vegetables, fruits, and dairy products -- will
> raise your blood glucose more quickly than meats and fats,
> but they are the healthiest foods for you. Your doctor may
> need to adjust your medications when you eat more
> carbohydrates. You may need to increase your activity level
> or try spacing carbohydrates throughout the day."
> http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp
>
> If you follow that advice, then your doctor has no choice
> but to "adjust your medications when you eat more
> carbohydrates" if you are over the recommended ADA A1c of
> 7%.
>
> Somehow, the possibility that those starches may be why you
> are over 7% in the first place just doesn't seem to be
> getting through.
>
> Nathaniel G. Clark, MD, MS, RD, who wrote:
>
> "(meeting the ADA target) to 6.5% (meeting the AACE
> target)?" it must be realized that within that range of A1C
> reduction the potential benefit is small indeed, based on
> current data"
>
> needs to read, among others, some quite old data from the
> EPIC-Norfolk study of Jan 2001:
> http://tinyurl.com/auxr2
> http://bmj.bmjjournals.com/cgi/content/abstract/322/7277/15?maxtoshow=&HITS=&hits=&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=EPIC-Norfolk+HbA1c&andorexactfulltext=and&searchid=1133254541690_817&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1
>
> "An increase of 1% in HbA1c was associated with a 28%
> (P<0.002) increase in risk of death independent of age,
> blood pressure, serum cholesterol, body mass index, and
> cigarette smoking habit; this effect remained (relative risk
> 1.46, P=0.05 adjusted for age and risk factors) after men
> with known diabetes, a HbA1c concentration >= 7%, or history
> of myocardial infarction or stroke were excluded."
>
> If you read that study fully, it will become clear that they
> are talking about the risk below 7%. Of course, things get
> worse above it.
>
> I find it interesting that the ADA has become defensive
> enough to see a need to publish this statement.
>
> Shades of Portia.
>
> "Methinks she doth protest too much"
>
> Cheers, Alan, T2, Australia.
> --
> Everything in Moderation - Except Laughter.

Everyone missed the whole point of the article. Re-read the statement:
"Although there are not good data to tell us the mean A1C in the U.S.,
diabetes experts often estimate that it is 8.5-9%. This suggests that we
should spend less time discussing what the goal should be and more time
discussing how to improve glycemic control, and thereby get more of our
patients to either goal. This point is particularly true when one realizes
that, based on available data, we would accomplish far more by targeting
those with high A1Cs and decreasing their A1Cs significantly than by arguing
about how to further improve the A1Cs of those who, most would agree, are
doing well by either standard."

Most regulars of this newsgroup set their goals much lower that the 7%
advocated by the ADA. I personally, as a T1, set my goals at 6% and my tests
average 5.8%.

If the mean in the U.S. was improved from 8.5-9% to the ADA goal of 7%, it
would be a vast improvement.

Sarah
T1


.

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