Viswanathan Mohan Part 6, What is the Average A1C in India?

In part 6, the conclusion of this Exclusive Interview, Viswanathan Mohan talks with Diabetes in Control Publisher Steve Freed about the average A1C of patients in his center and his approach for achieving the best A1C per individual.

Viswanathan Mohan, PhD, MD, DSc is the chairman of Dr. Mohan’s Diabetes Specialties Centre and president and director of the Madras Diabetes Research Foundation in Chennai, India.

Transcript of this video segment:

Freed:  I’m sure you monitor A1Cs–

Mohan: Yup.

Freed:  –for your patient base.

Mohan:  Yes, of course.

Freed:  What is your average A1C?

Mohan: Not very good. I think the clinic average is about eight, so it’s not very good. The average — of course there would be a significant number of people below 7 and below 6.5. But as the clinic gets more famous, what happens is that the worst cases will come to us. Physicians would treat them and then when they really get lost, they can’t do anything, go there now. (Laughs) So, we’ll get people with 14 and 15 A1C. And so, getting them down to seven is going to be a big dream. So, if we get them to nine first and then eight, then slowly inching down to seven. So, a large number of people do get to it. And now, we even the Libre and the continuous glucose monitoring, and so on. So, we teach people where their peaks are and how to control those. So, precision — we actually inaugurated the department precision diabetes a year ago. So, with that I think now the personalized treatment is getting better and better.

Freed:  Well, I’d certainly give you a lot of credit dealing with people with type 2 diabetes. It can be very difficult.

Mohan:  It is.

Freed:  And especially for the older person, getting them to change their lifestyle is almost impossible.

Mohan: Yes.

Freed:  But when you can talk to them and show them what’s going to happen and improve your quality of life–

Mohan:  True.

Freed:  –that you can enjoy life as you get older.

Mohan: That’s right.

Freed:  Some doctors have the philosophy, “Well, she’s 88 years, an 8 A1C is enough.” I don’t believe that. If she lives to 150,  she’s going to be miserable for 50 years. Everybody is entitled to normal blood sugars.

Mohan: So, we use the approach of the best A1C possible in that given patient without serious risk of hypoglycemia. So, we don’t set a target at all. They can reach 6.5, that’s good. They can reach six, that’s good. But if they can’t get below 8 without their life being all upside down and all the time they’re worried, they can’t go to sleep, they’re wondering whether they’ll wake in the morning, and they’re throwing a fit and they already have heart trouble, then we tell them, “Ease up. Now, this is enough. Let’s settle for something, 7.5, 8.” So, I guess we totally individualize. I don’t think age is a criteria at all. I agree with you.

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