Dr. Steven Edelman talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the A1C he would strive for, if he didn’t have diabetes, and what he’d strive for when working with his patients.
Dr. Steven Edelman, Founder, Director, and Chairman of the Board of the nonprofit organization Taking Control of Your Diabetes, is a Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at the University of California, San Diego and the Veterans Affairs Healthcare System of San Diego. He is also a 10-time winner of the San Diego Magazine Top Doctors in San Diego Award.
Transcript of this video segment:
Steve Freed: Let me ask you a question. This is always my favorite question. If you don’t want to answer, you don’t have to answer. That is, you leave here, you go downstairs to the display room and they’re going to be offering free A1C tests and they stick your finger and get a drop of blood and they give you a result and it’s accurate and that little piece of paper has a number on it. It doesn’t say below 7, it doesn’t say between 5 and 8, there’s a number with a decimal place. I call it the quality of life number because that number really, there’s other factors, that number really determines pretty much when you’re going to die and what kind of life you’re going to have. If you could have number that you wanted on that piece of paper, regardless, forgetting about diabetes, if you could have any number that you want, what number would you want that to be?
Dr. Edelman: For the A1C. I would say low 7s. 7.2, 7.3
Steve Freed: When you say low 7s, that’s still diabetes?
Dr. Edelman: You didn’t say that someone cured my diabetes.
Steve Freed: I’m not talking about you personally with your diabetes. I’m saying forget about that, regardless of that. You’re just someone that gets a piece of paper, you don’t have diabetes, what would you like that number to be?
Dr. Edelman: Low 5s. Now if you’re someone that has diabetes, if you take away all the reasons why we have to individualize it, then I’m thinking somewhere below 7.5 is a very safe place for most people. I think the AACE says you got to get below 6.5, I don’t believe that. There’s a lot of good data to show that, if you can get in the low 7s, that’s a very safe range. If you’re taking diabetes out of it, yeah, average blood sugar 120, that’s like 6.
Steve Freed: So, for a patient that comes to you is a type 2, not a type 1, what do you try to get to, what kind of level do you try to get to?
Dr. Edelman: For most people, less than 7.5, if I can get below 7 with no hypo, I have no problem with that. I do think that less than 7.5 is a good first start and then if you have comorbidities, I’m really happy less than 8. Someone who’s 90 years old, no evidence of any complications at all, because we know that high glucose leads to microvascular complications, which take 5 to 10 years to develop. I’m looking at cardiovascular risk reduction for sure.
Steve Freed: What about the kidneys? Do you see a lot of patients that have kidney issues?
Dr. Edelman: Yep, that’s blood pressure. If your A1C is below 7.5, you’re not doing yourself a disservice.
Steve Freed: So, you feel comfortable with that for most of your patients.
Dr. Edelman: Put it this way, I like to get them to 7 or below. If it’s going to cost you any side effects, too much hypo.
Steve Freed: Without causing hypos.
Dr. Edelman: I’d like to get them down as low as they can go. Yeah, for sure, but I think I’m a realist, Steve, I see people, it’s just not that easy. Easier said than done to say less than 6.5. AACE guidelines just don’t make any sense to me, they’re just not practical, they’re not realistic.