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A word on HbA1c

When I graduated from medical school, some 30+ years ago, HbA1c was the prime predictor of eye damage in relation to diabetes. It was the only reliable predictor at the time & probably still is.


We now give HbA1c more respect these days & its use has gone on to define pre-diabetes & diabetes. Raised HbA1c is indicative of pre-diabetes (HbA1c 41-49) & current guidelines regard an elevated HbA1c as acceptable for control of diabetes (HbA1c 50-55).

We now acknowledge that HbA1c in the pre-diabetes range also does damage to tissues if untreated & before diabetes is diagnosed. It therefore makes sense that we should be managing HbA1c per se anytime that it is found to be persistently elevated.


As a result I would like to suggest that the terms pre-diabetes & diabetes should be made redundant as they serve little purpose at this time in Medicine.


Conventional practice is to treat the elevated HbA1c with lifestyle measures, escalating through the ever increasing number of oral medications until insulin becomes necessary. We are told that diabetes is a progressive condition. I would like to think that this 'progression' could be stalled by non-pharmacological methods such as dietary manipulation & in particular LCHF/Keto eating. This would appear to be realistic in recent studies.


I am not quite sure what to name the elevation of HbA1c but it should be relatable to patients. I would welcome suggestions. Should it just be called hyperglycaemia?

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