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1. The A1c recommended level should be lowered

   • John H. Lange

   Envirosafe Training and Consultants

   Based on the study by Khaw et al (1) there appears to be considerable risk for cardiovascular disease and mortality when the A1c level is 5% or greater. The American Diabetes Association and American Association of Clinical Endocrinologists recommend an A1c goal for diabetics of 7% and 6.5%, respectively (2). Based on Khaw’s study, I suggest that this goal for A1c be lowered to a value of 5%.

   References

   1. Khaw T-T, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004;141:413-20.

   2. Palumbo PJ. The case for insulin treatment early in type 2 diabetes. Cleveland Clinic Journal of Medicine 2004;71:385-405.

   Conflict of Interest:

   None declared

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   Published October 6, 2004