Sunday, June 24, 2007
The high point of the second day of the American Diabetes Association convention in Chicago has been not something I learned about diabetes in general. It is instead what I learned about myself.The convention could not be better organized. Everything goes off without a hitch, which has to be rema...
Of course the A1c is important. The DCCT showed us that. But within each subset of people with identical A1cs, then the evidence suggests that the variability is important.
In other words, you start by getting the A1c down. Then you try to minimize complications further by smoothing out the peaks.
I agree with your approach and that's how we do it in our programs.
Also David, don't forget the excellent work you did comparing A1c methods and making readers understand that not all A1c tests are created equal. While your result may have served to comfort you, you also know that the immunoassay method is highly inaccurate.
I would also like to mention that moving away from a once a year test as the gold standard (A1c once a year is great for most practitioners treating type 2 patients) is a money losing proposition for most of the people in that audience. To question the status quo is to open the proverbial can of worms and creates a tremendous gap in care that cannot be addressed given the current office-based health care model in the US.
By the way, I'm sorry that I missed seeing you here this year. I assume that you are also at the convention, but among a crowd of 17,000 it's easy for our paths not to cross!