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Short Summary
Main recommendation: Treat A1C as a three-month average of blood sugar, and aim for "as low as reasonably achievable" rather than a single fixed number, while avoiding frequent low blood sugars. The speaker explains that each 1 percentage point of A1C corresponds to roughly a 30 mg/dL change in average blood sugar, and that A1C alone can hide large day-to-day swings.
Key Points
- A1C measures the percentage of glucose attached to hemoglobin in red blood cells, which reflects average blood sugar over about three months because red blood cells live roughly that long.
- Conversion examples given: 6% is about 120 mg/dL, 7% about 150, 8% about 180, and 12% about 300.
- Dr. Ergin says the commonly cited general target is below 7%, based on studies linking lower A1C to reduced diabetes complications (he cites about a 30% lower risk per 1-point drop). He says newly diagnosed younger patients may aim lower, around 6.5% or 6%.
- Dr. Ergin says a low A1C does not mean good control if it results from frequent lows, and he cites the ACCORD study as showing more deaths when A1C was pushed very low, which he attributes to low blood sugars.
- A1C can hide fluctuations: a 50 to 250 mg/dL pattern can average to a 7% A1C, while a steadier 130 to 180 pattern gives a similar number.
- A1C is unreliable in conditions affecting red blood cells, such as anemia, iron or B12 deficiency, chronic kidney disease treated with erythropoietin, recent transfusions, bleeding, iron infusions, thalassemia, and sickle cell disease. In pregnancy, A1C may read falsely low.
Details Worth Noting
- Concrete instructions:
- Ask your clinician what your personal A1C goal is, and tell them about any low blood sugars and how they feel.
- Stick with the same lab when repeating A1C tests, since results can vary between labs (the speaker gives an example of 6.8% versus 7.1% from different labs).
- Track the trend over time (for example, 9% to 8% to 7%) rather than judging a single result.
- If A1C is unreliable for you, ask about alternatives: continuous glucose monitoring (personal devices such as Dexcom G6 or FreeStyle Libre, or a short professional wear of about one to two weeks), fructosamine (reflects about two to three weeks), glycomark (for people not taking SGLT2 medicines such as Jardiance, Farxiga, or Invokana), or regular finger-stick checks.
- Pregnant women with gestational diabetes should be aware that A1C can read falsely low and may still be used with that caveat.
- The speaker says that a 7% A1C can be healthy if daily readings stay near 130 to 180 mg/dL, but dangerous swings can be hidden in the same average.
Bottom Line
A1C is a useful average, but the speaker's point is that the number should be read alongside glucose fluctuations, low-sugar risk, and any red blood cell conditions that can distort it.
