Motivate patients by explaining Hb[A.sub.1c].
While I concede the arguments made for a more accurate reporting of true "mean" blood glucose levels instead of hemoglobin [A.sub.1c], this fact must be acknowledged: Hb[A.sub.1c] is now a household word with physicians, and that benchmark has motivated physicians to push for better diabetes control ("Panel Debates Best Way to Report Glycemic Values," February 2007, p. 60).
If an extra 5 minutes are spent with a patient to explain what Hb[A.sub.1c] means, it is almost certain that the light of understanding will shine in that patient's face, and he or she will exert more discipline to control diabetes. The use of "mean" blood glucose levels will muddy the waters for patients and physicians, because many patients use glucometers which read out blood sugar values that don't represent "mean" blood glucose levels. Many normal ranges for a variety of tests have been introduced to physicians, and have been accepted, if only clear teaching is provided; hence, changing the range of the Hb[A.sub.1c] to represent true glucose mean levels can be made acceptable and continue to be an easy compass for diabetic control.
Sydney O. Fernandes, M.D.