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Dace Trence Part 2, A1C and Diabetes

In part 2 of this Exclusive Interview, Dace Trence talks with Diabetes in Control during the AACE 2018 convention in Boston about A1c and diabetes: the current usefulness of the A1C test & why looking at ranges may matter more than averages.

Dace Trence MD, FACE is the Director of the Endocrine and Diabetes Care Center at the University of Washington in Seattle.


Transcript of this video segment, Dace Trence Part 2, A1C and Diabetes:

Freed: Now, let’s talk about A1C. I always thought that was the gold standard. When I would sit down with a patient, first thing I did before I did anything, I did an A1C test. I knew exactly — and I used the home test, so I knew exactly where I was, how much work was going to be involved. They would say, “Steve, what do you charge for your services?” I’d say, “Well, depends on your A1C. If your A1C is eight and above, it’s $475 an hour. If your A1C is below five, my services are free.” So, let’s work to get your A1C down, so my services are free. And just from that number, they weren’t lying; I can tell if they were lying, that they’re eating all the right foods and everything. So, the A1C had its day and its time. But what I discovered was that with the CGM that it’s not all about A1C, because that’s a 90-day average. We need to have the information on a daily or hourly basis. And because of the variability, now we have studies that show the variability of your blood sugar is just as important as the final number. So, what are you thoughts when it comes to the A1C test? Is there another test that you like better than the A1C?

Trence: Well, certainly A1Cs are the gold standard. We all know that. It’s in the literature. We’re all familiar with it. There’s been a lot of average energy, really trying to make that a recognizable number that everyone should know about and everyone should be able to interpret. So, clearly I like your charges, although I’m not sure I’d agree with them but I do like the charges. But again, as you mentioned, it’s on average. And it’s an average that you could get —  let’s say, I’m gonna make up a number. Let’s say you have an A1C of 10, so that’s an average of 1 and 20, 1 and 20, 1 and 20. That’s also an average of 8 and 12, 8 and 12, and an average of 9 and 11, 9 and 11. Now, what does that tell you about the control if you’re trying to say — again, if you say the variability versus the tightness of the range? So, if you think about it, isn’t the range more important? And I think this is where, again, with the continuous glucose sensors, we’re moving into interpretation of time and range that has a lot more meaning. It tells you how much time am I spending and where I really want to be. And you can argue that the range may be X, Y or Z, but by definition it’s still within a tighter amount of lower and higher blood sugar. And even more importantly, it tells you how much time am I spending where I don’t want to spend time, which is the super lows or lows, or the super highs. And an average won’t tell you that.

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