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Dr. Keith Roach
To Your Good Health
Dear Dr. Roach: I read your recent column on A1C levels. You said that 7% to 7.5% was ideal for most people. For older people, you said 8% can be good. My longstanding understanding of A1C levels is that less than 5.7% is good, 5.7% to 6.4% indicates prediabetes, and greater than 6.4% indicates diabetes. I am totally confused; could you please unconfuse me?
I am 94, and my most recent A1C was 5.9%. I take metformin and a host of other drugs daily. -- M.S., PhD
Answer: I am sorry to have confused you. It's best not to have prediabetes or diabetes at all, so having a normal A1C level (below 5.7%) is optimal. But if you have diabetes, then the A1C goal depends on the person. For a young person with Type 1 diabetes, an A1C in the normal range is ideal but often hard to achieve due to the risk of too-low blood sugar. The risk of developing organ damage, especially to the eyes, kidneys and nerves, is lowest when the A1C is normal.
In older people, most of whom have Type 2 diabetes, a goal of 7% is reasonable for most. A large study (ACCORD) showed us that in people with known blockages in the arteries of the heart (or those who are at a very high risk for blockages), an A1C goal of 7% led to better outcomes than an A1C goal of 6%.
In older people who have multiple medical problems, an A1C goal that isn't so stringent (compared to a strict goal) may improve their quality of life without significantly increasing the risk of complications that take years to develop.
With my patients who are in their 90s, once their A1C levels are below 7% (and certainly below 6%), I consider stopping their diabetes medications one by one while watching their sugar levels and A1C numbers. But some elect to continue the medications.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.