Lucky 7
Last month, smack in the middle of Diabetes Awareness
Month, a group of health advocates joined 50 U.S. mayors to
launch a campaign called “Aim. Believe. Achieve: The
Diabetes A1C Initiative.”
Here at HSI, we consider every month to be Diabetes
Awareness Month. After all, type 2 diabetes is a disease that
affects more than 11 million U.S. citizens, but it’s estimated
that less than half of those 11 million have adequate control
of their blood sugar levels. So awareness obviously needs to
be a 12-month project.
And that’s the crux of the A1C Initiative: to make type 2
diabetics and their doctors aware of a simple test that can
help keep close tabs on blood sugar.
Sounds simple enough. Except that according to ABC News
the A1C Initiative has raised controversy among many
doctors.
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The seven percent solution
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I’ve referred to the A1C test in several e-Alerts because
researchers sometimes use the test to measure results in trials
that involve diabetes.
One of the ways to assess the severity of hyperglycemia
(high blood sugar) is to determine the percentage of
glycosylated hemoglobin (HbA1c) in the blood. A fasting
glucose test shows the blood sugar level at the time of the
test, but the A1C test reveals the average measurement of
HbA1c percentage in the blood over the 60 to 90 days prior
to the test date, providing a much more reliable profile of
blood sugar level.
In a nutshell: An HbA1c level of five percent is considered
safe, and seven percent or less is considered normal. A level
higher than seven is a red flag, signaling the possibility of
type 2 diabetes.
The title of the Diabetes A1C Initiative program is “A1C<7%
by 2007,” and as the name implies, the goal is to encourage
as many type 2 diabetics as possible to focus on reaching the
7 percent A1C target for their blood sugar levels over the
next two to three years. Getting tested is easy – it only takes a
single drop of blood – but it does require a visit to the doctor.
Ideally the A1C test should be conducted three or four times
each year; especially for those who are at high risk of
diabetes or have problems controlling blood sugar levels.
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Skeptics collide
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So Where’s the controversy in A1C? Apparently only at
ABC.
According to an ABC News report that coincided with the
A1C Initiative launch, “many doctors are skeptical” about the
A1C Initiative. But only two skeptical doctors are quoted in
the article. One of them feels that the A1C test is being
promoted by “experts” who are affiliated with drug
companies. Of course, he doesn’t mention that finding an
expert, doctor or researcher in mainstream medicine who
hasn’t been affiliated with a drug company would be as rare
as finding a boxcar filled with hens’ teeth.
The other skeptic is a doctor and researcher who feels that
controlling blood sugar in diabetics is relatively unimportant
compared to more pressing issues for diabetics, such as
cigarette smoking, blood pressure and the use of the diabetic
medication metformin. Yep – amazing but true – he
considers the use of metformin to be more important than
controlling blood sugar.
Metformin is the most common mainstream medication
prescribed to type 2 diabetics. It comes with a black box
warning to indicate that the drug has been associated with a
condition called lactic acidosis that can have fatal side effects
for patients with kidney disease and congestive heart failure.
And yet, in spite of that high profile warning, a 2002 study
found that as many as one out of four patients who are
prescribed metformin have kidney dysfunction, congestive
heart failure, or both.
So if there’s any real controversy in the ABC article, it’s the
contradiction between the two doctors who are skeptical
about the A1C Initiative – one claiming that it’s promoted by
drug company interests, and the other emphasizing the
importance of drug use over blood sugar control.
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Let’s get real
————————————————————
Meanwhile, those two skeptical doctors are overlooking one
glaringly obvious element of the A1C Initiative: The
campaign does not in any way downplay the importance of
other health factors that affect diabetics, it simply emphasizes
the need to control blood sugar levels – a factor that should
not be underestimated.
In the e-Alert “Sugar Shock” (9/28/04), I told you about
research from Johns Hopkins University that analyzed the
association between heart disease in diabetic subjects and the
severity of hyperglycemia. After reviewing 13 individual
studies, the Hopkins team concluded that hyperglycemia may
be directly associated with an increased risk of heart disease
in people with diabetes. The researchers estimated that every
time HbA1c increases by one percentage point, the risk of
heart disease or stroke raises by nearly 20 percent. Likewise,
when HbA1c percentage drops, heart disease risk drops as
well.
Without question, all diabetics should quit smoking and pay
close attention to other health factors associated with their
condition. But to dismiss the importance of blood sugar
levels is foolish. Especially when a simple test provides an
easy way to monitor this key marker of diabetic health.
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Just between you and me
Confidentiality isn’t what it used to be
My husband and I recently applied for a new life insurance
policy, which required us to take physical exams. And of
course, among the paperwork that we filled out there was a
confidentiality statement promising that the results of our
exams would be strictly private.
When the exam results came back, we weren’t surprised
when my husband’s cholesterol was on the high side. It’s
been high for awhile now, we’ve known about it, and he’s
taking steps to address it (although you can be sure that he’s
NOT taking a statin drug).
What DID surprise me was something that arrived in the mail
just a couple of days later. It was a flier, addressed to my
husband, with tips on how to lower cholesterol. The flier was
sponsored by a drug company. And it’s the first one he’s ever
received.
Think I hit the ceiling? Uh YEAH! We’re still repairing
ceiling tiles.
Our new insurance company agreed not to share our medical
exam results with our doctor, the government, our insurance
broker, etc. But apparently that confidentiality doesn’t extend
to drug companies that like to offer friendly “tips” on how to
lower cholesterol.
In short, their definition of confidential and mine are
somewhat different.
Mine means you keep something in confidence. Theirs means
we’re confident we can do something valuable with this
information.
To Your Good Health,
Jenny Thompson
Health Sciences Institute
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