the article seems to buy into the myth about what the ADA has regarding
what a1c goals, which is not what they advise...

this is from their own site...

"The better your glucose control, the less likely you are to develop
complications of diabetes.  An A1C in the sevens (7s), however, does
not represent good control.  The ADA goal is LESS than 7 percent.  The
closer your A1C is to the normal range (less than 6 percent), the lower

your chances of complications.  However, you increase your risk of
hypoglycemia, especially if you have type 1 diabetes.  Talk with your
health care provider about the best goal for you."

the key words "less than 6 percent)

Sally

Interesting article. The basic flaw for type 2's appears
here:

"However, we must consider the cost-benefit relationship.
Placing the patient on another oral medication or starting
the patient on insulin needs to be weighed against the
potential benefit of further A1C reduction. If the question
is, "What should be done to decrease my patient's A1C from
6.9% (meeting the ADA target) to 6.5% (meeting the AACE
target)?" it must be realized that within that range of A1C
reduction the potential benefit is small indeed, based on
current data."

Read that again, and see if you can find any mention of
diet, lifestyle or exercise. The basic assumption is that
the ONLY way to decrease the patient's A1c is "another oral
medication or starting the patient on insulin".

And, unfortunately they are correct if the philosophy
followed is based on this:

"The message today: Eat more whole grains!  Whole grains and
starches are good for you because they have very little fat,
saturated fat, or cholesterol.  They are packed with
vitamins, minerals, and fiber.  Yes, foods with carbohydrate
-- starches, vegetables, fruits, and dairy products -- will
raise your blood glucose more quickly than meats and fats,
but they are the healthiest foods for you.  Your doctor may
need to adjust your medications when you eat more
carbohydrates. You may need to increase your activity level
or try spacing carbohydrates throughout the day."
http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp

If you follow that advice, then your doctor has no choice
but to "adjust your medications when you eat more
carbohydrates" if you are over the recommended ADA A1c of
7%.

Somehow, the possibility that those starches may be why you
are over 7% in the first place just doesn't seem to be
getting through.

Nathaniel G. Clark, MD, MS, RD, who wrote:

"(meeting the ADA target) to 6.5% (meeting the AACE
target)?" it must be realized that within that range of A1C
reduction the potential benefit is small indeed, based on
current data"

needs to read, among others, some quite old data from the
EPIC-Norfolk study of Jan 2001:
http://tinyurl.com/auxr2
http://bmj.bmjjournals.com/cgi/content/abstract/322/7277/15?maxtoshow=&HITS=&hit
s=&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=EPIC-Norfo
lk+HbA1c&andorexactfulltext=and&searchid=1133254541690_817&stored_search=&FIRSTI
NDEX=0&sortspec=relevance&resourcetype=1

"An increase of 1% in HbA1c was associated with a 28%
(P<0.002) increase in risk of death independent of age,
blood pressure, serum cholesterol, body mass index, and
cigarette smoking habit; this effect remained (relative risk
1.46, P=0.05 adjusted for age and risk factors) after men
with known diabetes, a HbA1c concentration >= 7%, or history
of myocardial infarction or stroke were excluded."

If you read that study fully, it will become clear that they
are talking about the risk below 7%. Of course, things get
worse above it.

I find it interesting that the ADA has become defensive
enough to see a need to publish this statement.

Shades of Portia.

“Methinks she doth protest too much”

Cheers, Alan, T2, Australia.

I'm not going to bother to look it up again and post it here as was done
before, but the ada in a somewhat recent guideline said that where other
complications don't prevent it, an a1c of less then 6 is a good goal.  
What they mean of course is to avoid lows for people whose drugs might
cause them if not well controlled.

I note that the logic used for not trying to go from a 7 to a 6.5 was that
adding more drugs to do so adds more complications then it is worth.  
What is missing of course is to moderate the carb intake on the diet side
of the glucose intake and insulin available equation to reach that and
even lower a1c numbers. That goal can be reached by eating to one's meter
to bring into balance that equation. Then even folk who use drugs and
could be in danger of lows can have lower numbers, I know people with
type1 in the 5 club for long periods using this approach.  As they say,
there is no lower a1c number where complications don't occur.