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Going Beyond A1C


Last year, diaTribe published this article about using some other glucose measures along with A1C to measure diabetes outcomes.  https://diatribe.org/beyonda1c

A year later, this topic is picking up steam.  There has been a lot of discussion lately about A1C vs Time In Range (or how much time we spend at our blood sugar goal, how much time higher, and how much time lower).

What are your thoughts?  Which measure is more important to you?  Which measures does your health care team discuss with you?

My endo discusses both A1C and Time In Range, but he is more concerned with the latter.  I have a low A1C number, and he is concerned that I spend too much time with low blood sugars.  It's something we're working to solve - even at the cost of bringing my A1C up a bit.

posted Aug 3 in Conversation by KarenG (16,340 points)

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7 replies

A PWD can have a "good" A1c yet have a really wide standard deviation, i.e., have too many highs and lows.  For myself, I am slowly trying to narrow my range AND stay in range more often...and all this is much easier doing lower carb (20-30g/meal) and now using a pump (Omnipod).
answered Aug 8 by TortieGirl (3,950 points)
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Because I am anal retentive and very self-disciplined (comes from my nature and my former career) I have an A1C in the low - mid-5's. My Endo scolded me assuming I was low all the time. Fortunately I had been a lingtime Dexcom CGM'er (paid for out of pocket cuz the health plan didn't see the value of it) I had printouts.Shut the Endo up real quick.  A1C is just an average, to put it simply,let's say the goal is 5. If your bg's are 5,5 and 5 - your A1c is 5. But it would also be 5 if your readings were 0,5 and 10.  Time in range is far more valuable to me.
answered Aug 8 by artwoman (1,060 points)
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I'm a type 1 pwd with a type a personality so more data points is a good thing.  I got my CGM because I was up and down all over the place with a lot of spikes and awful anxiety.  And while insurance wouldn't cover it, it was by far one of the best investments I have ever made. Prior to CGM range was 40 to 350 constant swings and produced a lot of anxiety with 6.5 A1C.  Now my range is 70 to 180 with average of 145ish, in range 85-90% and my standard deviation is mostly Around 34 with high at 39.  I use the Dexcom software to monitor these three data points daily and focus making continuous improvement using the hourly in range data.  Anxiety is down and I don't worry about A1C - feel so much more in control (which is so important to me) and so much happier and can focus on other aspects of living.
answered Aug 9 by TeriV (160 points)
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My doctor uses the A1C exclusively.  I'm loosing weight, feeling more energized and more flexible but she doesn't take any of that into account.  The time in range isn't even a factor but I must be doing something right because in the last year I've bought my A1C down 1.5.  I'm proud of that.
answered Aug 9 by ecfb0404 (160 points)
This is the first time I'm hearing about "Time in Range". How often do you check your blood sugar each day to establish this? I'm a Type 2 diabetic, and none of the doctors I've gone to have instructed me to check my blood sugar so I do it now and then on my own, but I typically concentrate (or remember to do it!) when I first wake up.
answered Sep 14 by RaeNov (360 points)
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That's a great question, RaeNov.  I'm T1 so I don't have a good sense of blood sugar testing frequency for T2s but hopefully others can chime in.  Also, feel free to add your question to a new discussion thread to gather more feedback!
answered Sep 14 by KarenG (16,340 points)
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Thanks Karen! I just posted a new question. :)
answered Sep 15 by RaeNov (360 points)