Tracking HbA1C: Why So Many Are 'Doing It'
It’s common to see health behavior trends that elevate consumer interest. Going gluten-free continues to be a trend, because many consumers have decided it’s the “ultimate healthy diet,” despite research that suggests the approach is only appropriate for individuals with celiac disease or gluten sensitivity. Tracking waist measurement has also become a more popular habit for many, given the disease status that obesity has and its link to other conditions.
With the incidence of diabetes continuing to escalate, it seems that more Americans are also tracking their HbA1c levels.
HbA1c is a blood test that shows the average blood sugar levels over the prior three months. You do not have to fast for this test. It helps with evaluating how well blood sugar is being controlled if you were diagnosed with diabetes and using lifestyle and/or medications to control the condition. HbA1c is also recommended by the American Diabetes Association (ADA) to screen for diabetes, in conjunction with a fasting blood sugar level and glucose tolerance testing. If it is being used to diagnose diabetes then “less than 5.7 percent” is considered normal, between 5.7 percent and 6.4 percent is considered pre-diabetes, and over 6.5 percent is diagnostic criteria for diabetes. It should be noted that if you are managing diabetes, HbA1c (treatment) control goal should aim for 7 percent, while more recent research suggests a goal “below 8 percent.” The ADA points to tight control as having a more optimal outcome with regards to vascular changes. More recent studies suggest that a more forgiving goal may be easier for many patients.
The study published in the Journal of the American Medical Association (JAMA) used data on 23,482 individuals over age 20 who participated in the National Health and Nutrition Examination Survey (NHANES), focusing specifically on HbA1Cc trends during 2007-2008 and 2013-2014. The prevalence of HbA1c use was noted among both genders in three sub groups based on age ― individuals ages 20 to 44, individuals 45 to 65, and individuals older than age 65. The researchers noted a significant uptick in patient-reported awareness of HbA1c tracking between the two date periods.
The overall rate of patient reported awareness in the 2007-2008 periods was 52.32 percent, and in the 2013-2014 periods it was 74.31 percent. This suggests a significant uptick in awareness.
Also of note is that among the two older subsets, there was a notable change in patient awareness of clinician-set target HbA1c goals, meaning that patients were not just aware of their numbers, but there had also been an increasing level of awareness of the goal their clinician wanted them to aim for. What’s interesting is that the higher awareness seemed to coincide with the 2012 American Diabetes Association recommendations to “seek a less stringent 8 percent HbA1c goal” in patients being treated for diabetes who had issues with hypoglycemia, advanced vascular changes, significant co-morbid conditions, or difficulties with longstanding diabetes. The theory is that this “kinder approach” may have helped to drive patient interest in compliance.
It’s also important to recognize that the 2017 Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on Comprehensive Type 2 Diabetes Management Algorithm supports this patient-interest finding and recommends lifestyle optimization, weight loss, individualized HbA1c goal (aiming for 6.5 percent IF feasible), glycemic control using self-testing, individualized management, minimization of hypoglycemia, minimization of weight gain, among other recommendations.
Based on this study, loosening up the end goal of treatment for many patients seems to have encouraged more interest in the HbA1c and in achieving the recommended target goal. There is often a discussion among lifestyle experts and healthcare providers as to whether choosing easier or more attainable goals is preferable to trying to get patients to persist and achieve lofty lifestyle goals. There’s a diversity of opinions regarding that approach, but it’s worth considering that in this case, “lightening the load” in terms of target HbA1c goals seemed to result in more people being willing to monitor and achieve those more reasonable goals.
It’s worth conjecturing that for weight goals for obesity management, maybe it’s worth considering smaller weight loss goals, too. If the patient’s response to a higher standard will result in a total turn off to weight loss efforts, then identifying patients more amenable to baby steps or easier goals is better than thwarting their efforts if they feel it’s too hard to achieve the recommended goal. Another approach could be tiered milestone effort ― achieving an initial goal that is maintained, and then recommending another weight loss effort. This could also work for patients with diabetes ― using a “tiered” HbA1c goal approach.
The key is an individualized approach that considers a person’s personality, stage of disease, financial abilities (for uncovered services), and management skills to determine the best approach. For some patients it may be baby steps, while other individuals may be willing to target and achieve more rigid and lofty goals. It’s a case of know thyself, and for the healthcare provider, know thy patient!
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