Recently the Food and Drug Administration (FDA) hosted a Public Workshop on August 29, 2016. An excellent article was written in advance of the Workshop by the diaTribe members. The focus of the FDA meeting was “Going Beyond A1c – One Outcome Can’t Do It All”.

For many diabetics, both type1 (T1D) and type2, routinely have hemoglobin A1c (A1C) tests as part of their medical appointments. The thoughts and feelings of many T1D run the gambit. Feelings of fear, disgust, failure, shame and disappointment are only just a few due to the fact that A1C results are used to assess diabetes therapy. Have you ever chosen to not study and took an exam without any preparation for a final exam grade?  For many of us, this author included, exams can be a very challenging event. This raises the question. How can a T1D prepare for an A1C exam? What do we measure, when do we measure, how do we measure are all key questions?

Peter Drucker once said, “If you can’t measure it, you can’t improve it.” Let us look at changing the question facing a T1D. How can we take immediate actions during each and every day that could result in improved A1C results?

In January 2013, I launched the start of collecting and analyzing my continuous glucose readings with the start of a Personal Dexcom G4 Platinum continuous glucose monitor (PCGM). A YouTube, 3DviaT1D is a presentation of my startup and desires with the addition of a Dexcom unit. The next, challenge came with my 65th birthday. The fight with Medicare was over the best approach to manage my condition with my use of a PCGM unit

Using selected reports from Dexcom Studio software, reports were assembled to support the importance and value of using a PCGM. An article has appeared in the American Journal of Managed Care regarding my Medicare Appeal fight. Be sure to reference the pdf link to the complete article which contains five figures. After a twenty-four month period, the figures demonstrated that hypo and hyperglycemic events had been reduced. The objective of near normal blood glucose via A1C of 7.0% without the two to three fold increase in hypoglycemic events which was a major factor reported in the Diabetes Control and Complication Study.

Now, what can we assemble in ongoing reports which can assist T1Ds in gaining better control in our A1C tests? The FDA August 29, 2016 meeting date was one month prior to my next endocrinologist appointment in September 2016. My A1C exam was taken on September 20, 2016. Could Dexcom Clarity software reporting present a key to compare my laboratory results and a tool for daily choices? The period reporting results were as follows:

A.   DEXCOM Readings from DEXCOM Clarity Reports
Average CGM
Date CGM Standard
Start End Range Estimated glucose Deviation
Date Date in days A1C mg/dL mg/dL
08/22/16 09/05/16 15 6.7% 147 51
09/06/16 09/20/16 15 6.6% 144 50
06/23/16 07/22/16 30 6.7% 145 56
07/23/16 08/21/16 30 6.5% 141 46
08/22/16 09/20/16 30 6.7% 145 51
06/23/16 08/06/16 45 6.6% 143 53
08/07/16 09/20/16 45 6.7% 144 49
06/23/16 09/20/16 90 6.6% 144 51
B.   Laboratory Results
Actual Glucose
Date   A1C mg/dL
9/20/2016 . . . . . . . . . 6.9% 151

 

There have been various comments regarding the accuracy and the time frame windows for A1C exam readings given the fact that an A1C reading is just one number as an average of blood glucose attached to a hemoglobin molecule. It is interesting to note that the data presented above for estimated A1C has a high correlation to the precise value obtained by the laboratory for A1C and Glucose level over various iterations of time frames.

How were the Dexcom Clarity Reports Assembled?

    1. The determined data range was adjusted and changed in the Overview Designation below your name.
    2. Next the report was produced and run from the Data Designation below your name.
    3. Finally, a report was produced and run from the Compare Designation below your name.
    4. It was after receiving my A1C results from the laboratory, September 20, 2016, that the various time range reports were run and assembled into the matrix table listed above.

 

The ability does exist through the use of Dexcom Clarity to get a feel as to the range of one’s estimated A1C via their Dexcom reports prior to your A1C test. The comparison listed above demonstrates a high correlation to the actual laboratory results. Anyone using a Dexcom unit, either G4 or G5 has the ability to view moving glucose levels. It is the small day to day adjustments which can bring about a change in results. How can we take actions to change the direction of the glucose flow direction as reported on our receiver unit or cell phone? One suggestion is to get a copy of Sugar Surfing by Dr. Stephen Ponder. Dr. Ponder is a pediatric endocrinologist and certified diabetes educator.

As diabetics we need to take action with mechanical devises and directed actions to drive our glucose levels to a near normal ranges and reduce the roller coaster events for each and every day. You can check your daily results. Again, in Dexcom Clarity go to the Data Designation. Below your name and time frame title, on the far left are three choices. Click Daily. Now you have supporting documentation as to what is happening on a daily basis. Documented output facilitates discussions with health care professionals to determine optimal approaches. It is the ongoing success of small changes repeated over time that can have the potential for better A1C exam results.

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