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When a A1C of 6.5 May Not be Right for You

Nina Ghamrawi, MS, RD, CDE
2
January 12, 2022

What does it mean to have a perfect glucose range? What does it mean to have a perfect A1C? You may have heard that a target A1C is 6.5-7% for people with Diabetes. But an A1C of 6.5 is not the right goal for everyone. To know what is best for you and reduce your risks of diabetes complications, it’s important to know which target glucose and A1C are work for your own situation.

Do You Have a History of Heart Attack or Stroke?

If you have a history of heart attack or stroke, then an A1C goal range of 7-8% may be best for you. Research suggests that an A1C below 7% puts a patient with heart disease and history of heart attack or stroke at increased risk for heart attack or stroke. However, there are several exceptions to this guideline, so it is always best to talk to your doctor about what A1C range is best for your condition and history.

For patients with pre-diabetes, or A1C of 6-6.4%, there is already an increased risk of heart attack or stroke. Controlling, or lowering A1C during the pre-diabetes stage is always best. However, if you have Type 2 Diabetes and are newly diagnosed in the recent 7 years, tighter control with A1C 6.5-7% may still be appropriate for you to reduce diabetes-related death and microvascular complications.  

Are You Having Type 1, LADA, or Otherwise Taking Glucose-lowering Medications?

If you have Type 1 Diabetes, LADA, are on insulin, sulfonylureas, SGLT-2 inhibitors, glinides, or other glucose-lowering medications, then a lower A1C at or below 6.5% may not be appropriate, and may put you at increased risk of having hypoglycemia or developing hypoglycemia unawareness. If you’re in this situation and have no other heart disease risks, then an A1C of 7-7.5% may be a better target range. To know for sure what is best for you, always consult your provider to help set or adjust your target A1C range.

If You Do Not Take Insulin and Have No Known Heart Disease Risks…

If you are not taking insulin to manage your glucose, and you do not take any oral medications that cause low glucose, then 6.5-7% would be most clinically suitable for you based on ADA guidelines. Contact your provider if you are unsure of what goal A1C is right for you.

Takeaways

Any time you are concerned about your glucose ranges, or you’ve been told that you are meeting your glucose goals but you still want to improve glucose further, then always seek advice from your provider to know what glucose range is best for you, or whether it is safe to lower your glucose more. Based on your condition, medical history, and medications onboard, your doctor will be able to advise you on the most appropriate A1C goals.