Libre CGM vs A1c

Dean,

As @Michel mentions, an office based A1c measurement is a very good measurement of your glycated hemoglobin.

Your A1c is excellent, and nothing that in my opinion should concern you. You are well below the area where your risk of complications is increasing rapidly. [see graph below]

When a physician tells you that your A1c is a measure of your average glucose reading they are over-simplifying the situation. I think they use this simplification as a way to communicate with patients in a way that leads to action i.e. my A1c was 9, I have to get my average glucose levels down to improve my A1c.

I think that anytime your blood glucose is above a personal set point the glucose molecule is attaching and your hemoglobin gets glycated. So if you have an average of 95, but had many peaks with high levels, i.e. like my son, who has many peaks into the low 300’s, then during these times your hemoglobin is getting glycated at a fast rate. So this may part of the issue.

Additionally, each person gets rids of red blood cells at a different rate, so if your body is slow to get rid of red blood cells, then you will have more glycated hemoglobin staying around longer. Also in the A1c test, the last week will have more impact than the first week. So if you had stellar control three months ago, but it slipped lately, the A1c will overemphasize the near rather than the far term. There are also, many other variable I haven’t discussed.

My point, is your A1c is excellent. If there is more you can do, great, go for it. If you are happy with where you are in your lifestyle, I personally wouldn’t worry and wouldn’t look back.

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