What is the optimal A1C goal? Healthy non-diabetics HbA1C range is within 4.2-4.6%. Many-experienced diabetics have been achieving the above range.
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Best A1C target/goal
Fit non-diabetic person’s A1C percentage is always within 4.2 to 4.6%. These numbers are only from individuals who are fit, non-obese, active, and on a healthy diet.
The A1C result depends upon how well you are maintaining your blood-glucose level. If you are maintaining your blood sugar at an optimal range 70-85mg/dl (3.9-4.7mmol/l) at most of the time, then your A1C be in the normal range 4.2-4.6%.
A1C goal advised by American Diabetes Association (ADA)
- A1C goal of 6.5% or less is a more stringent goal. This A1C target is for people who do not experience many hypoglycemia episodes. This may be for individuals who have recently diagnosed with diabetes.
- A1C goal of 7% is reasonable. This A1C target is for many adults with diabetes who are not pregnant.
- A1C goal of 7.5% is for children with diabetes (0 to 18 years old). In children, younger than 6 years may be unable to recognize hypoglycemia symptoms.
- A1C goal of 8% or less is considered a less stringent goal. This A1C target may be for people with severe hypoglycemia experience. This may be for individuals who have many years of diabetes and who have a low life expectancy.
A1C goal advised by Canadian Diabetes Association (CDA)
- A1C goal of 6.5% or less is for type 2 diabetics to lower nephropathy and retinopathy risk further. They must balance against hypoglycemia risk.
- A1C goal of 7.1-8.5% is for those who have longstanding diabetes with a history of recurrent severe hypoglycemia. And for those who have a limited life expectancy. This target is for those who are hard to achieve an A1C ≤7%. That too after effective doses of multiple anti-hyperglycemic agents, including intensified basal-bolus insulin therapy.
A1C goal advised by Australian Diabetes Society (ADS)
- A1C goal of 6% or less is for people with short duration diabetes, without cardiovascular disease and managing with lifestyle change.
- A1C goal of 6.5% or less is for people with short duration diabetes managing with anti-diabetic agents. And for individuals who control diabetes with insulin.
- A1C goal of 7% or less is for people with long-duration diabetes or cardiovascular disease.
- A1C goal of 8% or less is for people with recurrent severe hypoglycemia or for those who are hypoglycemia unawareness.
A1C goal suggested by Dr. Richard K. Bernstein
One of the secrets of life is to make stepping-stones out of stumbling blocks. ~Jack Penn
Dr. Richard K. Bernstein is a physician and type 1 diabetes advocating low-carb diet to help achieve normal blood sugars. He is the author of the book "Diabetes Solution." In page 54 of the 3rd edition of this book, he declared his A1C is consistently 4.5%. Additionally, his patient’s normal A1C range is from 4.2 to 4.6%.
Then, why even after the greatest effort most of us have A1C of 5.2 to 5.6%. You may be lean, healthy eating, exercising, and caring teeth & gums (source of infection), then why not able to achieve A1C goal. What could go wrong? Other infections, sleep deprivation or stresses might prevent you from reaching your A1C goal.
A1C less than 4.2% are unusual and only when people have anemia or other RBCs abnormality.
Diabetics on insulin or sulfonylureas may experience hypo if they prefer healthy A1C goal. So, the American Diabetes Associations set a goal of 7.0% for these individuals.
Those who do not take insulin or sulfonylureas can achieve A1C below 5%.
An A1C of 7% is equivalent to an average blood sugar level of 180 mg/dl. It is more than double of the normal range. Long-term A1C of 7% may lead to various diabetes complications.
A1C target suggested by Clinical Studies
A study showed A1C less than 5% had the lowest rates of cardiovascular disease (CVD). Moreover, any number over 5% increased CVD risk. Reference: Association of hemoglobin A1C with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Annals of Internal Medicine 2004 Sep 21; 141(6):413-20.
Another study showed a stronger correlation between A1C and CVD. There is a linear increase in CVD as A1C raise above 4.6%, corresponding equivalent BS of just 86 mg/dl. It also showed heart disease risk among non-diabetics doubles for 1% raise over 4.6%. Reference: Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study. Archives of Internal Medicine 2005 Sep 12; 165(16):1910-6.
From the above studies, you can understand any number above 4.6 or 5% is not healthy, whether you are diabetic or not. If you want to be healthy and expect reasonable life expectancy, then you should try to achieve A1C of below 5%.
What should be my HbA1c level?
The clinical studies, as well as Dr. Richard K. Bernstein experience, confirms an A1C target of 4 to 4.6% is the best. This goal helps to avoid diabetes complications and provide longest life expectancy.
Non-diabetic A1C is usually between 4.0 to 5.0%. For diabetics, both type 1 & 2, A1C target should be <5.0%. A1C levels above 5.0% increase your risk towards diabetes complications.
It is better for diabetics to lower the HbA1c level. However, the hypoglycemia risk is high, if you try achieving A1C below 4.6%.
How damaging or dangerous is a hemoglobin A1C of over 8?
An A1C of over 8% is surely not okay. At the same time, it does not mean you are going into ketoacidosis, coma, or die! However, you should take it seriously as a danger alarm.
A1C of 8% does not mean your kidneys are going to fail, heart stop working, or you are going to blind tomorrow. However, it might happen, if it stays there for years.
Many have an A1C close to or even more than 8% when first diagnosed as diabetic. It is possible to bring under 7% in just 3 months then below 5% if you put consistent effort. You should strive to take it below 7% at your earliest. High level for months are dangerous; still, you have time to turn around.
How frequently, I have to test my A1C.
Once diagnosed with diabetes, it is nice to have at least four A1C tests per annum. If you are health conscious, then it is up to you to test A1C even monthly until reached your target by modifying treatment regimen. Do not forget, your A1C decides your risk for diabetes complications.
If you reached your stabilized target A1C, then take A1C test two to four times yearly.
If your A1C is on a higher side, do not panic, you can lower it with consistent effort. You can learn more by visiting a lower A1C level.