HbA1C and Diabetes

I have been asked on various occasions why I don’t use the HbA1C test on my diabetic patients. The answer is simple–I don’t need it. I monitor my diabetics by fasting and two-hour postprandial blood glucose (sugar) levels. The two-hour postprandial blood glucose (abbreviated 2 hr pp BSL) tests the blood sugar when the patient has not eaten anything overnight and in response to a standard breakfast. (For details on the test, look under Discussion Files and Atherosclerosis Screening Test.) The HbA1C test is a measure of the average blood sugar over the last six months, mainly months 3-6, not months 0-3. The HbA1C averages both the fasting and 2 hr pp BSL, with more weight on the 2 hr pp BSL. Anything that elevates the BSL at any time during the last six months–say influenza–will elevate the HbA1C even though blood sugar levels may be perfectly normal at present. The HbA1C was advocated for use because of its “convenience,” and not because it is superior to monitoring the blood sugar–indeed, the HbA1C is not all that accurate. In any event, I have been using the fasting and 2 hr pp BSL for almost 40 years now and no treated patient of mine has had anything more than a few background retinal micro-aneurysms (the hallmark of diabetes)–and even such patients are few and far between. Some of my diabetic patients have developed renal failure–as have some of my non-diabetic patients–but none have required dialysis, except a few patients, already in renal failure, whom I inherited from other physicians. My goals in treatment are to keep the fasting BSL under 125 mg/dl and the 2 hr pp BSL under 200 mg/dl. The reason for the latter goal is because micro-aneurysms are rare when the 2 hr pp BSL is kept below this level. My diabetics who have never smoked cigarettes die at an average age of 79-80 years, which is beyond the normal lifespan of Americans.

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