Rethinking Blood Sugar Markers: Why HbA1c Might Not Be the Best Metric
Feb 02, 2025
During a recent Pro Insider Hangout discussion, Tisha, one of our subscribers, raised an important question about how clients react to glucose spikes. While many individuals tracking their glucose with continuous glucose monitors (CGMs) feel alarmed at even minor fluctuations, the real issue may not be the spikes themselves but how metabolic health is measured and interpreted.
The Problem with HbA1c as a Health Marker
Dr. Bikman addressed this concern by expressing strong reservations about HbA1c as a key health metric. While A1C has become a standard for assessing long-term blood sugar levels, he believes its widespread use has led to an overreliance on a number that may not be as informative as once thought. In fact, the introduction of HbA1c testing led to the decline in the use of the oral glucose tolerance test (OGTT), which historically provided a more comprehensive picture of metabolic health.
According to Ben, A1C is subject to too many variables, including red blood cell lifespan, which makes it an unreliable standalone metric. He argues that its adoption has, in some ways, created unnecessary concern and driven people toward medications earlier than necessary.
As a Reminder... You can use the “gear” icon at the bottom of the video to watch at various speeds.
Changing Definitions of “Normal” Blood Sugar
Another key point Dr. Bikman raised is how the definition of “normal” blood sugar levels has shifted significantly over the past 50 years. Decades ago, fasting glucose levels of around 160 mg/dL were considered diabetic; today, that threshold has been lowered to 126 mg/dL. Similar trends have occurred with LDL cholesterol levels. While some argue that these changes reflect better scientific understanding, Dr. Bikman remains skeptical, suggesting that lowering these thresholds allows for earlier and more frequent medical interventions.
Which Markers Provide a Clearer Picture of Metabolic Health?
Instead of focusing solely on glucose or A1C, Dr. Bikman advocates for looking at insulin levels and triglycerides—both of which provide more meaningful insights into metabolic health. However, these markers are often overlooked, partly because there are no widely prescribed medications targeting them.
The Takeaway
Rather than relying on a single number like A1C, a more complete approach to metabolic health involves looking at multiple markers, including fasting insulin and triglyceride levels. Understanding how the body regulates these factors over time can provide better guidance on metabolic health and the risk of developing insulin resistance.
While it’s natural to want definitive markers for health, blindly relying on A1C or other singular metrics may not be the best approach. A more holistic view—one that includes insulin, triglycerides, and overall glucose response—can provide a clearer picture of long-term metabolic well-being.
Participate in These Face-to-Face Discussions
Become a Pro Insider to enjoy opportunities to engage more with Dr. Bikman in discussing the concepts of improving metabolic health. Click below to learn more: