February 3, 2016
A1c Should Not Be the Only Goal for Type 2's
The American Diabetes Association (ADA) has officers that are harming people with type 2 diabetes. Dr. Robert Ratner, chief scientific and medical officer for the ADA, is the doctor doing much of the harm to type 2 patients on oral medications. Dr. Ratner does not recommend blood glucose testing, but relying on the A1c test when you have a doctors appointment.
Studies have found glucose fluctuations and daily glucose control are something people with type 2 diabetes are often not aware of and may need to consider. For the many Americans living with type 2 diabetes, A1c is an important metric as it is a key clinical measure of a person's glycemic control over a two to three month period. A controlled A1c level, typically a level at 7 percent or less, has been shown to be associated with a reduction in risks for microvascular complications and cardiovascular events.
While A1c levels are a key component of determining long-term glycemic control, they provide very little information about blood glucose fluctuations that occur throughout the course of a day. A person with type 2 diabetes can experience substantial glycemic excursions following meals. Although there is no prospective clinical trial evidence, there is broad and robust experimental and epidemiologic evidence supporting the concept that excessive glycemic excursions may contribute to long-term risks. In the absence of confirmatory clinical trials, however, direct cause and effect remains controversial.
This points to the urgent need for research and trails exploring the results of daily testing on patients with type 2 diabetes and what these excursions may mean to the health of the patients. Testing programs need to be developed that will demonstrate the importance of blood glucose testing, especially self-monitoring of blood glucose (SMBG). There is much that needs to be accomplished to undo the actions of people like Dr. Ratner.
It is important for people with type 2 diabetes to be aware of glucose fluctuations throughout the day. As patients and physicians become more aware of excessive glucose excursions, both dietary and therapeutic strategies can be implemented to reduce these fluxes. Studies have shown an optimal treatment regimen not only helps bring patients' A1c to goal. It can also help improve daily glucose control throughout the day. Improved glycemic control helps reduce severe fluctuations that have been linked to short-term complications, and which may also lead to long-term microvascular complications and cardiovascular events.
Antidiabetic agents may reduce daily fluctuations and help patients achieve levels of glucose control within the normal range throughout the day. A1c is and will remain a key measure of glycemic control, but as understanding of diabetes grows, the quality of glycemic control may also become an important marker of treatment success.
While I agree that these are important reasons for people to know the importance of blood glucose testing, very few trials consider this in conjunction with low carb, high fat meal plans that can prove very beneficial in lowering the glycemic excursions to hyperglycemia and hypoglycemia. Most doctors ignore the teachings of Dr. Richard Bernstein and his 'law of small numbers' in the treatment of diabetes.