Nov 21

What Is A1C and Why Is It Important?

insulin shot for diabetesLast week we commented on the wave of television and other advertisements for diabetes medications. It is unlikely that you can watch TV for more than a few “prime-time” hours without seeing an ad for products like Jardiance, Lyrica, Toujeo, Trulicity, Farxiga or Lantus. These ads picture big, burly firemen at work and bike-riding seniors whose diabetes is under control after taking this or that medication. Many of the commercials also state that patients were able to reduce their “A1C.”

So, what is “A1C” and why is it important? If you are being treated for diabetes, you have probably heard this term. Without becoming too technical, A1C is a measure of your average blood glucose levels over a period of about three months. This average level is used to tell the physician whether a patient is normal, “prediabetic” or has type-2 diabetes. If the patient is known to be diabetic, the A1C test is used to determine how well the treatment is working.

The A1C test is related to, but not the same as a blood glucose or “fasting blood sugar” test. That second test is a snapshot of glucose levels at a given time. It requires the patient to fast for several hours before testing so that recently ingested calories do not give a falsely high reading. The A1C test measures the amount of hemoglobin (the oxygen-carrying material in your blood) that is attached to glucose molecules.

The more glucose (sugar) that you have carried in your bloodstream over time, the higher the concentration of glucose-attached hemoglobin will be. Blood is drawn, but fasting is not required for the A1C test.

This value is recorded as a percentage. An A1C level below 5.7% is considered normal, a reading of 5.7% to 6.4% alerts the doctor to “prediabetes,” and if the percentage of glucose-attached hemoglobin is 6.5% or higher, the diagnosis of type-2 diabetes is made. Doctors pay a lot of attention to A1C levels because it gives them a good idea of what kind of treatment to start or how well existing treatment is doing. In at least one of the medication commercials, a patient boasts about how much their A1C level has declined since starting treatment.

This is true, but patients should remember that lifestyle changes (diet and exercise) can also reduce A1C levels. It is certainly true that type-2 diabetes is due in part to a genetic component, but it is modern eating and exercising habits that have made type-2 diabetes the “growth market” it has become. We repeat that “From a business point of view, this is an opportunity; from a public health viewpoint, it is a disaster.” You can measure how big the opportunity is by counting those commercials.

As a general surgeon, especially as a weight loss surgeon, A1C is a concern for two reasons. First, if A1C levels are too high, surgery of all kinds becomes more problematic because high glucose levels dispose the patient to more surgical complications. Second, bariatric surgery has helped to demonstrate that type-2 diabetes and its symptoms, including elevated A1C levels, are often fully reversible. Weight loss surgery has proven to reduce blood glucose levels, body mass index and diabetic complications in many patients.

If your primary care doctor or a specialist has told you that your A1C level is high, you should do your best to reduce it with first line measures like diet and exercise and then medication. These measures can work, but many patients are simply unable to achieve desired goals with diet, exercise or even drugs. Weight loss surgery may become an option in those cases. Only a complete evaluation by a qualified physician or surgeon can determine this. Depending on many factors, bariatric surgery may be the best option. If you have any question about weight loss surgery or other areas included in general surgery, please contact our office. You may use Contact Dr Birkedal or phone us at (386) 231-3530. Our offices, located in Daytona, New Smyrna and Palm coast are all part of the Florida Hospital Network

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