From the Guidelines
A patient with diabetes mellitus (DM) who achieves a hemoglobin A1c (HbA1c) below 6.5% through lifestyle modifications is still considered to have diabetes. The American College of Physicians guidance statement 1 emphasizes that diabetes is a chronic condition that requires ongoing management and monitoring, even if blood glucose levels are well-controlled. The statement highlights the importance of personalized goals for glycemic control, taking into account the benefits and harms of pharmacotherapy, patient preferences, and individual characteristics such as life expectancy and comorbid conditions. Key points to consider include:
- Diabetes is a chronic condition that can be managed but not cured
- Achieving an HbA1c below 6.5% through lifestyle modifications does not remove the diagnosis of diabetes
- Healthcare providers will continue to classify patients as having diabetes in remission or with well-controlled diabetes
- Regular monitoring remains essential to catch potential complications early
- The American Diabetes Association recognizes that some patients can achieve "remission" if blood glucose levels remain normal without medication for at least three months, but this doesn't mean the condition is permanently gone 1. Therefore, even if a patient's HbA1c level drops below 6.5% through lifestyle changes, they are still considered to have diabetes and require ongoing medical care and monitoring.
From the Research
Definition of Diabetes Mellitus (DM)
A patient with diabetes mellitus (DM) is typically defined by their blood glucose levels, with a hemoglobin A1c (HbA1c) level of 6.5% or higher being a common diagnostic criterion 2.
Achieving HbA1c Below 6.5% Through Lifestyle Modifications
Some studies suggest that lifestyle interventions, such as diet and exercise, can be effective in reducing HbA1c levels in patients with type 2 diabetes 2, 3. For example, a study found that lifestyle interventions were associated with reductions in the incidence of diabetes and improved intermediate outcomes, such as reduced weight and blood pressure 2.
Implications of Achieving HbA1c Below 6.5%
However, achieving an HbA1c level below 6.5% through lifestyle modifications does not necessarily mean that a patient can be considered non-diabetic. The underlying pathophysiology of the disease is still present, and the patient may still require ongoing management and monitoring to prevent complications 4, 5.
Key Points to Consider
- A diagnosis of diabetes is based on multiple factors, including blood glucose levels, medical history, and physical examination 4.
- Lifestyle modifications can be effective in reducing HbA1c levels, but may not necessarily mean that a patient can be considered non-diabetic 2, 3.
- Ongoing management and monitoring are still necessary to prevent complications, even if HbA1c levels are below 6.5% 4, 5.
- The use of medications, such as metformin, may still be necessary to achieve and maintain glycemic control 5, 6.
Treatment Options
Treatment options for patients with type 2 diabetes who achieve an HbA1c level below 6.5% through lifestyle modifications may include: