A Dose of Dr. E: Why the A1c Sucks (And Why Time in Range Is More Important)

11 Comments
    class="comment even thread-even depth-1" id="li-comment-4367">
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    Thanks. Very important information for us.

    class="comment even thread-odd thread-alt depth-1" id="li-comment-4373">
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    Thanks Steve, this is very helpful!

      class="comment byuser comment-author-lynne odd alt depth-2" id="li-comment-4392">

      Rhonda,
      Thanks for your comment. TIR refers to glucose values either from a home glucose monitor or a CGM device. You and others on our blog would be interested in a very recent publication that took a ton of glucose values from their personal glucose meter and the authors looked at the relationship between TIR and diabetes complications. They found that there was a significant reduction in eye and kidney disease in those with more numbers in the 70 to 180mg/dl range. The major lesson is to use your home glucose meter a lot to know how you are doing and to improve your time in range. For the folks using a CGM…look at the information that you get closely.

    class="comment even thread-even depth-1" id="li-comment-4377">
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    they should put it in a smart watch some how
    we could all ware one of those

    class="comment odd alt thread-odd thread-alt depth-1" id="li-comment-4388">
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    Is there a text version for us deaf people?

    class="comment odd alt thread-even depth-1" id="li-comment-4410">
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    I am a Type 2 taking 4 Metformins and 4 Glipizides a day and I have been told that my insurance won’t pay for a CGM so I am stuck with A1c.

      class="comment byuser comment-author-lynne even depth-2" id="li-comment-4416">

      Hi Bruce,
      At the current time, if you’re not on insulin, CGM isn’t covered as it is fairly expensive. In the future they will be more accessible, and will really help open your eyes to how different foods, activities and medications affect your blood sugar. Hang in there with that sucky A1c! It’s fine for now. The Freestyle Libre can be purchased from any pharmacy with a prescription and is not that expensive. For example, the reader is a one-time charge which is approximately $60, and each sensor which lasts 2 weeks is about $50. Lastly, you may not need to wear one 24 -7, you may just need to put it on every once in a while to see how you’re doing.

    class="comment odd alt thread-odd thread-alt depth-1" id="li-comment-4433">
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    Dr. Edelman,

    I have been diabetic since age 4 and 1/2 (March 18, 1956 I was regulated for Type 1 at UCSF after being diagnosed by my primary doctor and mother the end of February). I am now on Medicare and struggling to be able to continue my normal routine of control due to rules and regulations of Medicare. I cannot seem to qualify for a CGM (have been trying for over 5 years now) though you have said you feel all Type 1’s should have one. I am now being told that Medicare and my secondary insurance will not cover my Life Scan One Touch test strips and I must change to FreeStyle and cut myself to 3 tests a day. I am so frustrated with this I don’t know what to do – I keep trying but I continue to hit road blocks. Any thoughts as to what I can do?
    Thank you for any help you can give.

      class="comment byuser comment-author-lynne even depth-2" id="li-comment-4464">
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      Hi Marilyn,
      If you are a type 1 on injections or a pump, you should be able to get strips for your meter and a CGM from Medicare. Your caregivers have to fight a little for you. You can email me off the blog at steve@tcoyd.org and I will try to help you.

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