QuickRead MedCheck – Diabetes, Part 1: Glycemic Control

Contributor: James “Dr. J” Agtuca

 

Diabetes means so many things to so many people — while a straightforward condition for some, it is the very definition of ‘complicated’ for others. Certainly of no help are the endless streams of information that either exaggerate — typically by oversimplifying — pharmaceutical treatment options, or complexify even modest therapeutic regimens.  When all is said and done… diabetes boils down to one fundamental concept: GLYCEMIC CONTROL.

                  Realize that many factors play a role in determining how successful (or not) a person’s diabetes management is. To name a few… age, duration of diabetes [diagnosis], previous glucose control, presence of atherosclerotic cardiovascular disease (ASCVD), risk of hypoglycemia — or “low blood sugar” — episodes, medication(s), level of stress, metabolic rate, dietary habits, and physical activity. These 10 factors are key determinants of how “good” or “bad” someone’s diabetes control is; however, even the most experienced endocrinologists and specialized dietitians know that glycemic control is what determines whether a person’s A1C level is above, at, or below goal.

                  What exactly is A1C? In short, a person’s A1C level is a lab value that indicates their average level of glucose (or “sugar”) over a 2- to 3-month timeframe. An ideal A1C level is anything less than 5.5%. An A1C level of 5.5% to 6.4% means a person has elevated blood glucose levels, indicating poorly controlled diabetes and/or confirming a diagnosis of pre-diabetes. Needless to say, an A1C level of 6.5% and greater [and paired with another diagnostic lab/test value — for example, an elevated fasting plasma glucose (FPG) reading greater than 125 mg/dL] confirms diabetes.

                  The main issue and most pressing concern of chronically elevated A1C levels and FPG readings is the corresponding risk of health complications. Diabetes complications are divided into microvascular (i.e. due to damage to small blood vessels) and macrovascular (i.e. due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) – leading to blurriness/blindness – damage to kidneys (nephropathy) – leading to renal failure – and damage to nerves (neuropathy) – leading to impotence and diabetic food disorders… which include severe infections leading to amputation. Macrovascular complications include insufficient blood flow to legs as well as cardiovascular events like heart attacks and strokes.

                  The takeaway point from all of the above, however, is this: For every percentage point reduction in A1C level, the risk of said microvascular and neuropathic complications is reduced by 40%. Moreover, every 1% reduction contributes to long-term reduction in risk of macrovascular disease (e.g. peripheral vascular disease) and cardiovascular events (e.g. myocardial infarction… or “heart attack”). Evidence from large randomized-controlled trials — not limited to the Action to Control Cardiovascular Risk in Diabetes (ACCORD), Diabetes Control and Complications Trial (DCCT), United Kingdom Prospective Diabetes Study (UKPDS), and Veterans Affairs Diabetes Trial (VADT) — indicate that good metabolic control in diabetes can delay the onset and progression of said complications.

                  So, what does “good metabolic control” mean and how precisely does one lower their A1C level? Come back to the Nu-U Fitness blog in 2 weeks for the answers to these questions and more in Part 2 of this article!

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