So the other week I was thinking about the relevance of the a1c, how it is applied in a clinical setting and how we as people with diabetes are often judged by our clinicians and also our peers.
As technology gets more sophisticated such as pumps, cgms’s, software will have access to more data than we have ever had.
Traditionally the a1c is the benchmark that we refer too, we talk about it, we feel guilty about it when it is a higher number than we hoped for and feel pure elation when we get a magic number.
Now I don’t need to explain to many that our control can at times resemble something similar to a Manhattan whilst occasionally it will resemble something smoother, more controlled and it is the latter that we all strive for.
So what the heck are you going on about Mike? Well let’s put this simply. Using the a1c sucks as a measurement. It is next to useless as an informative evaluation tool. Why Mike?
Let’s take person A and person B. Both have a a1c of 7% and they both test their blood at least 4 times a day whilst following similar treatment plans.
So person A has many highs and many lows, so when combined and averaged out equals 7%. It may make person A tired more often, possibly with more complications, whilst possessing lack of confidence maintaining control, not generally not feeling quite as healthy as they would like to be.
Person B on the other hand, tends not to swing so low and keeps the highs at bay which again equates to 7%. The day-to-day deviation is less, which means a graph would resemble more like a subtle wave.
So with that my theory is that the A1c is fundamentally flawed. Everyone who has the same percentage will likely have very different control patterns if we were able to map it out.
So how do we go about measuring our control? Unfortunately I do not have that answer of the top of my head yet? Do we look to advance the A1c test? The technology behind it?
Or do we look for another test? Blood test with different markers? I don’t know if this is even possible. Did I mention that I do not have a degree in biomedical science. 🙂
How would you like to have diabetes measured? Perhaps more reliance on cgms’s? If that were an option.