Hemoglobin a1c lowering: Dignity Health | 5 Questions Women Should Ask Their Primary Care Physician

07.08.202327.06.2023 by alexxlab

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Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c: A Randomized Clinical Trial

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Randomized Controlled Trial

. 2022 Oct 3;5(10):e2238645.

doi: 10.1001/jamanetworkopen.2022.38645.

Kirsten S Dorans^{1

2}, Lydia A Bazzano^{1

2

3}, Lu Qi^{1

2}, Hua He^{1

2}, Jing Chen^{1

2

3}, Lawrence J Appel⁴, Chung-Shiuan Chen^{1

2}, Ming-Hui Hsieh¹, Frank B Hu^{5

6

7}, Katherine T Mills^{1

2}, Bernadette T Nguyen¹, Matthew J O’Brien^{8

9

10}, Jonathan M Samet^{9

11}, Gabriel I Uwaifo^{10

12}, Jiang He^{1

2

3}

Affiliations

¹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
² Tulane University Translational Science Institute, New Orleans, Louisiana.
³ Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
⁴ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁶ Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.
⁷ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
⁸ Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
⁹ Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
¹⁰ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
¹¹ Colorado School of Public Health, Aurora.
¹² Department of Endocrinology, Diabetes, Metabolism, and Weight Management, Ochsner Medical Center, New Orleans, Louisiana.

PMID:
36287562
PMCID:
PMC9606840
DOI:
10.1001/jamanetworkopen.2022.38645

Free PMC article

Randomized Controlled Trial

Kirsten S Dorans et al.

JAMA Netw Open.

2022.

Free PMC article

. 2022 Oct 3;5(10):e2238645.

doi: 10.1001/jamanetworkopen.2022.38645.

Authors

Affiliations

¹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
² Tulane University Translational Science Institute, New Orleans, Louisiana.
³ Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
⁴ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁶ Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.
⁷ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
⁸ Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
⁹ Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
¹⁰ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
¹¹ Colorado School of Public Health, Aurora.
¹² Department of Endocrinology, Diabetes, Metabolism, and Weight Management, Ochsner Medical Center, New Orleans, Louisiana.

PMID:
36287562
PMCID:
PMC9606840
DOI:
10.1001/jamanetworkopen.2022.38645

Abstract

Importance:

Low-carbohydrate diets decrease hemoglobin A1c (HbA1c) among patients with type 2 diabetes at least as much as low-fat diets. However, evidence on the effects of low-carbohydrate diets on HbA1c among individuals with HbA1c in the range of prediabetes to diabetes not treated by diabetes medications is limited.

Objective:

To study the effect of a behavioral intervention promoting a low-carbohydrate diet compared with usual diet on 6-month changes in HbA1c among individuals with elevated untreated HbA1c.

Design, setting, and participants:

This 6-month randomized clinical trial with 2 parallel groups was conducted from September 2018 to June 2021 at an academic medical center in New Orleans, Louisiana. Laboratory analysts were blinded to assignment. Participants were aged 40 to 70 years with untreated HbA1c of 6.0% to 6.9% (42-52 mmol/mol). Data analysis was performed from November 2021 to September 2022.

Interventions:

Participants were randomized to a low-carbohydrate diet intervention (target <40 net grams of carbohydrates during the first 3 months; <60 net grams for months 3 to 6) or usual diet. The low-carbohydrate diet group received dietary counseling.

Main outcomes and measures:

Six-month change in HbA1c was the primary outcome. Outcomes were measured at 0, 3, and 6 months.

Results:

Of 2722 prescreened participants, 962 underwent screening, and 150 were enrolled (mean [SD] age, 58.9 [7.9] years; 108 women [72%]; 88 Black participants [59%]) and randomized to either the low-carbohydrate diet intervention (75 participants) or usual diet (75 participants) group. Six-month data were collected on 142 participants (95%). Mean (SD) HbA1c was 6.16% (0.30%) at baseline. Compared with the usual diet group, the low-carbohydrate diet intervention group had significantly greater 6-month reductions in HbA1c (net difference, -0.23%; 95% CI, -0.32% to -0.14%; P < .001), fasting plasma glucose (-10.3 mg/dL; 95% CI, -15.6 to -4.9 mg/dL; P < .001), and body weight (-5.9 kg; 95% CI, -7.4 to -4.4 kg; P < .001).

Conclusions and relevance:

In this randomized clinical trial, a low-carbohydrate dietary intervention led to improvements in glycemia in individuals with elevated HbA1c not taking glucose-lowering medication, but the study was unable to evaluate its effects independently of weight loss. This diet, if sustained, might be a useful dietary approach for preventing and treating type 2 diabetes, but more research is needed.

Trial registration:

ClinicalTrials.gov Identifier: NCT03675360.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Dorans reported receiving grants from the National Heart, Lung, and Blood Institute outside the submitted work. Dr Bazzano reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.. Study Flow Diagram

eGFR indicates…

Figure 1. . Study Flow Diagram

eGFR indicates estimated glomerular filtration rate.

Figure 1.. Study Flow Diagram

eGFR indicates estimated glomerular filtration rate.

Figure 2.. Mean Estimated Primary and Secondary…

Figure 2.. Mean Estimated Primary and Secondary Outcomes

^a P < .05 for between-group net…

Figure 2.. Mean Estimated Primary and Secondary Outcomes

^aP < .05 for between-group net change from baseline.

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Noakes TD, et al.
Front Physiol. 2023 Mar 28;14:1150265. doi: 10.3389/fphys.2023.1150265. eCollection 2023.
Front Physiol. 2023.
PMID: 37057184
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References

1. National Center for Health Statistics . Leading causes of death 2017. Accessed September 21, 2022. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
1. Sarwar N, Gao P, Seshasai SR, et al. ; Emerging Risk Factors Collaboration . Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215-2222. doi:10. 1016/S0140-6736(10)60484-9
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1. World Health Organization; International Diabetes Foundation . Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF Consultation. World Health Organization; 2006.
1. Gerstein HC, Santaguida P, Raina P, et al. . Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies. Diabetes Res Clin Pract. 2007;78(3):305-312. doi:10.1016/j.diabres.2007.05.004
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1. Knowler WC, Barrett-Connor E, Fowler SE, et al. ; Diabetes Prevention Program Research Group . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. doi:10.1056/NEJMoa012512
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5 Ways to Lower A1C and Manage Your Blood-Sugar Levels

To lower A1C levels, you may need to lose weight, get regular exercise, regulate your carbohydrate intake, take insulin, or use medication like metformin.
A1C levels measure your blood sugar over a period of about 12 weeks and are an important indicator for people with type 1 or type 2 diabetes, as well as those at risk.
This article was reviewed by Jason R. McKnight, MD, MS, a family-medicine physician and clinical assistant professor at Texas A&M College of Medicine.
This story is part of Insider’s guide to Diabetes.

An A1C test measures the amount of glucose in your blood over the previous 12 weeks. This is important because it provides a long-term measure of blood-sugar levels, which are used to diagnose and manage diabetes or prediabetes.

Those with type 1 or type 2 diabetes should have their A1C levels measured about every three months. If you’re at an increased risk, you should have A1C measured twice a year, says Dr. Charles Richardson, the CEO of Cleveland Diabetes Care.

Through an A1C test, early detection of elevated blood-sugar levels can help reduce the risk of health complications from diabetes, like heart disease or kidney disease. Here’s what you need to know about A1C levels and how to lower them.

What is A1C?

A1C represents the amount of glycosylated hemoglobin in your blood. This is the amount of glucose that becomes attached to hemoglobin, a protein in red blood cells.

Over the normal 90-day life cycle of a red blood cell, glucose attaches faster in people with higher blood-sugar levels, Richardson explains. A1C measures the percentage of red blood cells that have hemoglobin that is coated with sugar, and it is an important marker of blood sugar.

Otherwise-healthy adults who are overweight — a risk factor for type 2 diabetes — should have their A1C measured every three years by having the doctor order blood work to test A1C. People who have no risk factors for diabetes and are not overweight do not need to check their A1C unless they or their doctor have cause for concern.

People with diabetes should have A1C measured about every three months, and more often if they have trouble controlling their blood sugars or if they are changing diabetes treatments.

Normal A1C levels

Your A1C levels can indicate the following:

Normal: 5.6% or lower
Prediabetes: 5.7% to 6.4%
Diabetes: 6.5% or higher

If you receive a diagnosis of diabetes or prediabetes, your doctor will work with you to set an individual target for your A1C levels. Most people with diabetes have a target A1C level of less than 7%. Doctors might set a higher goal for people with other health conditions like heart disease.

If you have diabetes or prediabetes, lowering your A1C is important. In fact, each percentage-point decrease in A1C levels can reduce risk of long-term complications from diabetes by 40%, according to the American Diabetes Association.

Richardson says the amount considered a significant reduction varies from individual to individual, so you should work with your doctor to set a personal goal. Dropping your A1C by even half a percentage point can have significant benefits, he says.

How to lower A1C

Your A1C levels are lowered when you reduce your average blood-glucose levels. This can be done through lifestyle changes and medication.

“With a multidisciplinary approach including optimal nutrition, implementing an exercise regimen, and diabetic medication, most patients can lower the hemoglobin A1C,” Richardson says.

Here are a few of the most effective ways to lower your A1C levels:

1. Lose weight

Losing weight can help you better control your blood sugars and lower your A1C levels.

A 2012 study published in the journal Diabetes Education found that losing 10% of body weight was linked to a 0.81% decrease in A1C levels for patients with type 2 diabetes.

2. Exercise regularly

“Exercising helps the body absorb glucose from the bloodstream and can help to make the body more efficient at accessing and utilizing glucose,” says Claudia Hleap, a registered dietitian based in Philadelphia who regularly works with patients to lower their A1C levels.

A 2017 study published in BMJ Open Diabetes Research and Care followed 65 patients with type 2 diabetes over eight years. One group completed 90-minute exercise sessions three times a week. Their A1C levels decreased by as much as 1.84%, and researchers concluded that people who exercised reduced their A1C more consistently than those who did not.

3. Count carbohydrates

Working with a dietitian to create an eating plan can help you lower A1C levels. In particular, people with diabetes and prediabetes need to monitor the amount of carbohydrates they eat, since carbs have the greatest effect on blood sugar.

“It is essential to undergo diet education in order to understand how eating certain foods will affect your blood sugars,” Hleap says. “Using this knowledge, it is important to move towards a consistent and controlled carbohydrate diet, in order to create lifelong sustainable dietary changes.”

A 2014 scientific review published in The Lancet Diabetes and Endocrinology found that people with type 1 diabetes who counted carbohydrates reduced their A1C levels 0. 64% more than people who did not count carbs.

For more information, read about how many carbs you should have a day if you’re diabetic.

4. Take oral diabetes medication

Oral diabetes medications, like metformin, can reduce your A1C levels. A widely cited 2012 scientific review in Diabetes Care found that metformin reduced A1C by an average of 1.12% for people with type 2 diabetes.

In addition, a 2019 study published in the Pakistan Journal of Medical Sciences followed 200 patients with type 2 diabetes. All of them saw their A1C levels drop within three months of taking metformin at the dose prescribed by their doctors, with the biggest decreases for people with higher starting A1C levels.

5. Use insulin

If your initial A1C levels are higher than 9% — most commonly for people with previously undiagnosed diabetes — your doctor might recommend starting insulin right away.

A 2010 scientific review published in Diabetes Technology and Therapeutics found that insulin regimens reduced A1C by an average of 1. 4% for type 2 diabetics.

Takeaways

Measuring A1C levels is an important way to monitor prediabetes and reduce your risk for diabetes complications. Working with a dietitian and your doctor can help you develop a plan to lower your A1C levels, but having patience is also important, Hleap says.

“Your hemoglobin A1C will not change overnight,” she says. “It is essential to make small and realistic changes one step at a time to ensure that the modifications you’re making to your diet and exercise regimen will be sustainable for the long term. These suggestions take time to implement. Mindset is important in making and sustaining these changes for the long haul.”

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Kelly Burch

Kelly Burch is a New Hampshire-based freelance journalist writing about finances, health, family, and more. Her work has appeared in The Washington Post, The Chicago Tribune, and Forbes, among others. Follow her on Facebook or Twitter, and or learn more here.

Get tested for glycated hemoglobin a1c in Podolsk. Price

Glycated hemoglobin (HbA1c) is an irreversible compound of glucose with hemoglobin in erythrocytes. This process occurs continuously and depends on the concentration of sugar in the blood and the duration of its effect on red blood cells. The level of glycohemoglobin does not change during the life of erythrocytes (90-120 days). Thus, the HbA1c indicator reflects the average concentration of glucose during the previous period (approximately 8-12 weeks) and allows a much better assessment of the degree of glycemia (the level of increase in blood sugar) than the determination of glucose in blood and urine.

When is a hemoglobin HbA1C test usually ordered?

Glycated hemoglobin, together with fasting glucose, is currently the most accurate tool for diagnosing diabetes mellitus (DM) and other forms of glucose metabolism disorders, including latent forms and gestational diabetes. The content of Hb1Ac is not affected by the time of day, exercise, diet, food intake, emotional stress and other external and internal factors that complicate the interpretation of other studies. This test is used to assess the compensation of the disease, the effectiveness of treatment and calculate the risk of complications.

An HbA1c test is required every 3 months for all patients diagnosed with diabetes.

What exactly is determined in the analysis process?

A specific type of hemoglobin, hemoglobin A1C, is isolated from a whole blood sample and measured by high pressure liquid chromatography.

What do the test results mean?

According to the World Health Organization (WHO), the concentration of Hb1Ac in healthy people is no more than 6.0%.

Values from 6.0 to 6.5% are considered borderline and may indicate disorders of carbohydrate metabolism: impaired glucose tolerance, prediabetes, diabetes.

Values above 6.5% are typical for diabetic patients.

Decreased glycohemoglobin levels may be observed in patients with anemia and in the recovery period of the body after blood loss

Usual test time.

Typically, the result of a glycated hemoglobin test is available within 1-2 days after blood donation.

How to prepare for the analysis?

No special training required. Detailed information can be found in the relevant section of the article.

You can donate blood during the day, no earlier than 3 hours after a meal or in the morning on an empty stomach. Pure water can be drunk normally. The day before, adhere to a standard diet, exclude alcohol.

According to the clinical guidelines “ALGORITHMS
SPECIALIZED
MEDICAL CARE FOR PATIENTS WITH DIABETES MELLITUS, 2015″:
less than 6% – normal level
6.0 -6.5% – borderline value
6.5% or more – diagnostic criterion level of DM (diabetic level).

Interpretation:
Elevated levels of glycohemoglobin are possible in the following conditions:
• diabetes mellitus (permanently elevated blood glucose levels)
• false positive result (associated with the presence of genetically abnormal forms of hemoglobin in the blood)
• patients after splenectomy (the level of glycohemoglobin may be increased due to an increase in the lifespan of red blood cells in the bloodstream)
Reduced level of glycohemoglobin is possible in the following conditions:
• hemolytic anemia
• erythropoiesis revival after blood loss

Take a blood test for glycated hemoglobin

In a healthy person who does not have a tendency to diabetes mellitus, the content of glycated hemoglobin in the blood is 4-6. 2%. If predisposed, the level rises to 5.7 to 6.4%. This health condition of the patient is called prediabetes. In the case when the level of altered hemoglobin reaches 6.5% or more, doctors suspect the presence of diabetes mellitus.

The rate of glycated hemoglobin may change with age. At thirty years, 4.9% is considered the norm. At forty years old, 5.8% is considered normal, At fifty years old, the norm is already 6.7%. In pregnant women, the result will always exceed the norm and reach up to 7.5%.

An elevated level of glycated hemoglobin does not appear in one day, its formation is a long process. Therefore, at an elevated level, doctors either talk about the onset of diabetes mellitus or impaired glucose tolerance.

A high level may not be associated with diabetes mellitus, but may occur against the background of:

Complete lack of physical activity.
Severe stress and depression.
A large amount of free Hb in the blood.
Tumor development.
Disorders of metabolic processes.

An increase in the percentage of altered Hb can be observed with hypervitaminosis caused by an excess of B vitamins.

A low level of altered hemoglobin will be direct evidence of the presence of life-threatening conditions for the patient. His fall is due to:

With a lot of blood loss.
With the development of anemia (anemia).
Incorrect dose of insulin administered to the patient.
With disorders in the work of the adrenal glands.
With hereditary predisposition.

Due to low blood sugar, the patient experiences a severe headache and complains of dizziness. A decrease in the level of glycated hemoglobin against the background of diabetes mellitus means the approach of a hypoglycemic coma. With a low level of glycated Hb, the following are observed:

Vision problems.
Drowsiness.
Frequent syncope.
Strong irritability.

When examining in this case, renal or hepatic insufficiency or pathologies associated with the destruction of red blood cells can be detected.

Causes of false results

Only insulin and drugs with a similar effect can change the result of the analysis. This group includes: Sulfonamides, Biguanides, Alpha-glycoside inhibitors. They urgently reduce blood sugar and therefore distort the result of the analysis – Repaglinide and Nateglinide.

False will be the numbers obtained from patients suffering from:

Anemia.
Diseases of the thyroid gland.

The level of glycated hemoglobin is affected by the intake of vitamins C and E.

The figures obtained immediately after blood transfusion will be overestimated.

Blood for the test is taken both from a finger and from a vein. The place of taking the material does not affect the result.

Hemoglobin a1c lowering: Dignity Health | 5 Questions Women Should Ask Their Primary Care Physician

Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c: A Randomized Clinical Trial

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Authors

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Conflict of interest statement

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Cited by

References

Publication types

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5 Ways to Lower A1C and Manage Your Blood-Sugar Levels

What is A1C?

Normal A1C levels

How to lower A1C

Get tested for glycated hemoglobin a1c in Podolsk. Price

When is a hemoglobin HbA1C test usually ordered?

What exactly is determined in the analysis process?

What do the test results mean?

Usual test time.

How to prepare for the analysis?

Take a blood test for glycated hemoglobin

Causes of false results

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