How to improve Hemoglobin A1C (HbA1C) levels?

From the Guidelines

To improve Hemoglobin A1C (HbA1C) levels, focus on a combination of lifestyle changes, including regular physical activity and a balanced diet, as well as medication management, with metformin as the first-line treatment, as recommended by the most recent guidelines 1.

Lifestyle Changes

• Adopt a low-carbohydrate diet rich in vegetables, lean proteins, and healthy fats while limiting refined carbohydrates and sugars.
• Aim for regular physical activity with at least 30 minutes of moderate exercise daily, such as brisk walking, swimming, or cycling, as suggested by the 2023 standards of care in diabetes 1.
• Monitor blood glucose regularly to understand how different foods and activities affect your levels.

Medication Management

• Metformin is typically the first-line treatment at 500mg once or twice daily, potentially increasing to 1000mg twice daily as tolerated.
• Other medications like SGLT-2 inhibitors (empagliflozin, dapagliflozin), GLP-1 receptor agonists (semaglutide, dulaglutide), or DPP-4 inhibitors (sitagliptin) may be added based on individual needs, considering the benefits of reducing HbA1c without hypoglycemia and favorable CVD outcomes 1.
• Insulin therapy might be necessary for some patients.

Additional Considerations

• Adequate sleep (7-8 hours nightly), stress management through meditation or deep breathing, and staying well-hydrated also help maintain stable blood glucose levels.
• A personalized approach to achieving the lowest possible HbA1c with the least amount of hypoglycemia and medication burden is essential, taking into account the unique needs and presentation of each patient 1.

From the FDA Drug Label

Table 2 shows HbA1c and FPG values for the entire study population Table 2 Glycemic Parameters in a 26-Week Placebo-Controlled Dose-Ranging Study PlaceboACTOS 15 mg Once DailyACTOS 30 mg Once DailyACTOS 45 mg Once Daily TOTAL POPULATION HbA1c (%)N=79N=79N=85N=76 Baseline (mean)10.410.210.210.3 Change from baseline (adjusted mean+)0.7-0.3-0.3-0.9 Difference from placebo (adjusted mean+)-1.0*-1.0*-1. 6*

Table 4 Glycemic Parameters in a 24-Week Placebo-Controlled Forced-Titration Study PlaceboACTOS 30 mg+ Once DailyACTOS 45 mg+ Once Daily Total Population HbA1c (%)N=83N=85N=85 Baseline (mean)10.810.310.8 Change from baseline (adjusted mean++)0.9-0.6-0. 6 Difference from placebo (adjusted mean++)-1.5*-1.5*

To improve Hemoglobin A1C (HbA1c) levels, treatment with pioglitazone (ACTOS) has been shown to produce statistically significant improvements in HbA1c and FPG at endpoint compared to placebo.

• 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 2.
• The mean reductions from baseline at Week 24 in HbA1c were 1.55% and 1.67% for the 30 mg and 45 mg doses, respectively 2.
• 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 2.3% and 2.6% and mean FPG of 63 mg/dL and 95 mg/dL, respectively 2.
• Treatment with ACTOS 30 mg resulted in reductions from baseline in mean HbA1c of 1.0% and mean FPG of 62 mg/dL for patients who had not been previously treated with antidiabetic medication 2.
• Treatment with ACTOS 30 mg resulted in reductions from baseline in mean HbA1c of 1.3% and mean FPG of 46 mg/dL for patients who had been previously treated with antidiabetic medication 2.

From the Research

Improving Hemoglobin A1C (HbA1C) Levels

To improve HbA1C levels, several strategies can be employed, including:

• Lifestyle modification, such as diet and exercise, which has been shown to be effective in reducing HbA1C levels 3
• Dietary changes, including a low-fat diet, low-carbohydrate diet, and low-calorie diet, which can improve glycemic control and reduce HbA1C levels 4
• Physical leisure time activities, such as walking, jogging, and gardening, which can improve glycemic control and reduce HbA1C levels 5
• Medications, such as sulfonylurea plus pioglitazone or metformin, which can improve glycemic control and reduce HbA1C levels 6, 7

Dietary Interventions

Dietary interventions that can help improve HbA1C levels include:

• A low-fat diet, which can improve glycemic control and reduce HbA1C levels 4
• A low-carbohydrate diet, which can improve glycemic control and reduce HbA1C levels 4
• A low-calorie diet, which can reduce fasting plasma glucose and HbA1C levels 4
• A healthy diet free of processed foods and sugar, and rich in nutrients such as fiber, vitamins, and minerals, which can contribute to maintaining controlled blood sugar and lipid plasma levels 4

Physical Activity

Physical activity, including moderate or vigorous physical leisure time activities, can improve glycemic control and reduce HbA1C levels 5. Examples of physical activities that can be beneficial include:

• Walking
• Jogging
• Gardening
• Tai chi chuan
• Qigong

Medications

Medications that can help improve HbA1C levels include:

• Sulfonylurea plus pioglitazone, which can improve glycemic control and reduce HbA1C levels 6, 7
• Sulfonylurea plus metformin, which can improve glycemic control and reduce HbA1C levels 6, 7
• Insulin glargine, which can improve glycemic control and reduce HbA1C levels, especially in patients with high baseline HbA1C levels 6