How to decrease Hemoglobin A1C (HbA1C) levels?

From the Guidelines

To decrease A1C levels, focus on a combination of lifestyle changes, including regular physical activity, such as aerobic and resistance exercise, for at least 30 minutes a day, most days of the week, as recommended by the most recent guidelines 1.

Key Lifestyle Changes

• Regular physical activity, including aerobic and resistance exercise, is crucial for improving insulin sensitivity and reducing A1C levels.
• Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking, cycling, or swimming, most days of the week.
• Incorporate resistance exercises, such as weightlifting or bodyweight exercises, to improve muscle strength and insulin sensitivity.
• Consider activities like yoga, tai chi, or other forms of exercise that can help improve flexibility, balance, and overall well-being.

Medication Management

• If prescribed medications like metformin, GLP-1 receptor agonists, or insulin, take them consistently as directed by your healthcare provider.
• Monitor your blood glucose levels regularly to understand how different foods, activities, and medications affect your levels.
• Work with your healthcare provider to adjust your medication regimen as needed to achieve optimal A1C levels.

Additional Tips

• Get adequate sleep (7-8 hours nightly) and practice stress management techniques like meditation to help regulate blood glucose levels.
• Stay well-hydrated and limit alcohol consumption to support overall health and well-being.
• Consider working with a registered dietitian or a certified diabetes educator to develop a personalized meal plan that takes into account your dietary needs and preferences.

By following these lifestyle changes and medication management strategies, you can effectively decrease your A1C levels and improve your overall health and well-being. Remember to consult with your healthcare provider before making any significant changes to your lifestyle or medication regimen.

From the FDA Drug Label

Compared with placebo, treatment with ACTOS titrated to a final dose of 30 mg and 45 mg resulted in reductions from baseline in mean HbA1c of 1.3% and 1.4% and mean FPG of 55 mg/dL and 60 mg/dL, respectively. For patients who had not been previously treated with antidiabetic medication (40%), mean values at screening were 10.3% for HbA1c and 240 mg/dL for FPG. At baseline, mean HbA1c was 10.4% and mean FPG was 254 mg/dL. Compared with placebo, treatment with ACTOS 30 mg resulted in reductions from baseline in mean HbA1c of 1.0% and mean FPG of 62 mg/dL. The addition of ACTOS to the sulfonylurea significantly reduced the mean HbA1c by 0.9% and 1.3% and mean FPG by 39 mg/dL and 58 mg/dL for the 15 mg and 30 mg doses, respectively. The addition of ACTOS to metformin significantly reduced the mean HbA1c by 0.8% and decreased the mean FPG by 38 mg/dL. The addition of ACTOS to insulin significantly reduced both HbA1c by 0.7% and 1.0% and FPG by 35 mg/dL and 49 mg/dL for the 15 mg and 30 mg dose, respectively.

To decrease A1C level, treatment with pioglitazone (PO) can result in reductions from baseline in mean HbA1c.

• The reduction in mean HbA1c can be achieved through monotherapy with pioglitazone, with reductions ranging from 1.0% to 1.4% 2.
• Combination therapy with pioglitazone and other antidiabetic agents such as sulfonylurea, metformin, or insulin can also reduce HbA1c levels, with reductions ranging from 0.7% to 1.67% 2. However, insulin (SQ) therapy can also decrease A1C levels, with similar reductions in HbA1c compared to NPH human insulin or insulin glargine 3.

From the Research

Methods to Decrease A1C Level

To decrease A1C level, several methods can be employed, including:

• Combination therapy with metformin, pioglitazone, and exenatide, which has been shown to be more effective than sequential add-on therapy in subjects with new-onset diabetes 4
• Using a fixed-dose triple oral diabetes polypill containing glimepiride, metformin, and pioglitazone, which has been found to have a trend towards a lower HbA1c compared to insulin plus metformin therapy 5
• Add-on glimepiride or pioglitazone therapy in patients with type 2 diabetes inadequately controlled on metformin monotherapy, which results in similar overall improvements in glycemic control 6
• Metformin-based dual therapies with sulphonylurea, pioglitazone, or DPP4-inhibitor, which have been found to be similarly effective in reducing HbA1c levels in drug-naïve Korean type 2 diabetic patients 7

Comparison of Therapies

A comparison of the metabolic effects of pioglitazone, metformin, and glimepiride over 1 year in Japanese patients with newly diagnosed type 2 diabetes found that:

• Pioglitazone, metformin, and glimepiride are equally effective in reducing blood glucose levels 8
• Pioglitazone has a favourable action on fasting plasma glucose and free fatty acids 8
• Glimepiride has a rapid action on blood glucose levels 8

Key Findings

Key findings from the studies include:

• Combination therapy with metformin, pioglitazone, and exenatide is more effective than sequential add-on therapy in reducing HbA1c levels 4
• Fixed-dose triple oral diabetes polypill therapy has a trend towards a lower HbA1c compared to insulin plus metformin therapy 5
• Add-on glimepiride or pioglitazone therapy results in similar overall improvements in glycemic control in patients with type 2 diabetes inadequately controlled on metformin monotherapy 6
• Metformin-based dual therapies are similarly effective in reducing HbA1c levels in drug-naïve Korean type 2 diabetic patients 7